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May 24, 2025Neurologic - Central neurological toxicity - Encephalitis
Signs & Symptoms
- Coma – Acute neurological deficit (aphasia, paralysis etc)
- Epilepsy – Confusion
- Might be rapidly worsening
Evaluation
- Brain MRI
- Lumbar puncture after brain imaging: analysis of CSF for white blood cell analysis (ideally including flowcytometry analysis), protein level, glucose level, presence for neoplastic cells
- Infectious workup (incl. viral and bacterial analysis in CSF and blood: according to local practice and epidemiology (eg varicella, hepatitis E, HSV1, HSV2, VZV, EBV, HIV,…):
- Lactate
- EEG
- Autoimmune serology: neuronal surface antibodies and/or intracellular neuronal antibodies according to clinical presentation in the serum (except anti-NMDA R Ab are done on CSF (can be done later, therefore keep CSF)
- ICPi-related encephalitis is an exclusion diagnosis
Management
Treat with following combination:
- 1-2mg/kg methylprednisolone IV
- 10mg/kg 3 x pd acyclovir until PCR for viral infections is negative
- 2gr 3 x pd ceftriaxone, 500mg 3 x pd metronidazole, 2gr 6x pd ampicilline until negative cultures
- ICU admission should be considered and cases should be discussed with a neurologist
- 1-2mg/kg methylprednisolone IV
- 10mg/kg 3 x pd acyclovir until PCR for viral infections is negative
- 2gr 3 x pd ceftriaxone, 500mg 3 x pd metronidazole, 2gr 6x pd ampicilline until negative cultures
- ICU admission should be considered and cases should be discussed with a neurologist