In:
Clinical and Experimental Neuroimmunology, Wiley, Vol. 12, No. 2 ( 2021-05), p. 127-134
Abstract:
Immune checkpoint inhibitor (ICI) therapy has revolutionized the management of multiple cancers with previously poor prognosis. Despite its efficacy the therapy is associated with a wide spectrum of immune‐related adverse events (irAEs) including neurological deficits ranging from peripheral neuropathy, myopathy, and myasthenic syndromes to encephalopathy or meningitis. Up to now, neurological irAEs, especially those with central nervous system (CNS) involvement, have been reported rather sporadically. Symptoms can be unspecific, which results in a diagnostic challenge. Methods In the study at hand, we report 5 patients who presented with symptoms of the CNS during ICI therapy indicating autoimmune encephalitis. Results Symptoms ranged from headache and hallucinations to symptoms of the brainstem to cerebellar syndrome. Radiological findings according to brain magnetic resonance imaging were unspecific, and analysis of autoantibodies remained negative in all cases. All patients underwent lumbar puncture, and examination of the cerebrospinal fluid revealed an elevated cell count, and thus an indication of inflammation, in 4 cases (80%). Consequently, all patients received high‐dose steroid treatment, and symptoms of all patients with elevated cerebrospinal fluid cell count significantly improved. Conclusions We demonstrate that symptoms of immune checkpoint inhibitor–induced encephalitis can be unspecific, and radiological findings are often inconspicuous. Thus, cerebrospinal fluid analysis is the most important examination to achieve a correct diagnosis, which in turn is decisive for a rapid start of therapy.
Type of Medium:
Online Resource
ISSN:
1759-1961
,
1759-1961
Language:
English
Publisher:
Wiley
Publication Date:
2021
detail.hit.zdb_id:
2508135-4
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