Mild (Aseptic meningitis)
Mild
Headache, fever and meningeal symptoms
Evaluation
- Brain MRI to exclude brain metastasis and leptomeningeal involvement
- Lumbar puncture after brain imaging: CSF
- white blood cell analysis (ideally including flowcytometry analysis)
- protein level
- glucose level
- presence for cancer cells
- infectious workup (incl. viral serologies and (myco)bacterial analysis in CSF and blood according to local practice)
- lactate
- Open pressure measurement (done during lumbar puncture)
Management
- Suspend ICPi untill clear diagnosis
- Exclude infectious cause before start of steroids
- Prednisone according to local practice: symptoms should disappear within 1 week if not: treat as severe aseptic meningitis
- Symptomatic treatment (paracetamol and NSAID)
- Restart of ICPi can be discussed in a multidisciplinary team if symptomatology was mild and steroids are stopped for some time
- Evacuating lumbar punctures to lower elevated ICP, consider other measures to lower elevated ICP
Abbrevations
CSF: Cerebrospinal fluid
ICP: Intracranial pressure
ICPi: Immune Checkpoint Blockade Inhibition
ICU: Intensive Care Unit
MRI: Magnetic Resonance Imaging
NSAID: Non Steroidal Anti-Inflammatory Drugs
