Background
Clinical Manifestations
- Encephalopathy, delirium, confusion, disorientation
- Seizures
- Aphasia or dysphasia
- Tremor, ataxia
- Dyscalculia
- Headache
ASTCT ICANS Grading1
| Domain | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
|---|---|---|---|---|
| ICE score | 7-9 | 3-6 | 0-2 | Unarousable |
| Level of consciousness | Awakens spontaneously | Awakens to voice | Awakens to tactile stimulus | Unarousable, stupor, coma, or requires vigorous or repetitive tactile stimuli |
| Seizure | — | — | Any that resolves rapidly, or nonconvulsive seizure on EEG that resolves with intervention | Life-threatening seizure >5 min or status epilepticus |
| Motor findings | — | — | — | Deep focal motor weakness, such as hemiparesis or paraparesis |
| ICP/cerebral edema | — | — | Focal or local edema on neuroimaging | Diffuse cerebral edema on neuroimaging; decerebrate or decorticate posturing;cranial nerve VI palsy; papilledema; or Cushing triad |
ICE Assessment Tool
| Domain | Description | Points |
|---|---|---|
| Orientation | orientation to year, month, city, and hospital | 4 |
| Naming | ability to name 3 objects (e.g. point to clock, pen, button) | 3 |
| Following commands | ability to follow simple commands (e.g. "Show me 2 fingers", "Close you eyes and stick out your tongue" | 1 |
| Writing | ability to write a standard sentence (e.g. "Our national bird is the bald eagle") | 1 |
| Attention | ability to count backwards from 100 by 10 | 1 |
Management
- High-dose steroids, depending on grading
References
- ^ Daniel W. Lee, Bianca D. Santomasso, Frederick L. Locke, Armin Ghobadi, Cameron J. Turtle, Jennifer N. Brudno, Marcela V. Maus, Jae H. Park, Elena Mead, Steven Pavletic, William Y. Go, Lamis Eldjerou, Rebecca A. Gardner, Noelle Frey, Kevin J. Curran, Karl Peggs, Marcelo Pasquini, John F. DiPersio, Marcel R.M. van den Brink, Krishna V. Komanduri, Stephan A. Grupp, Sattva S. Neelapu. ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells. Biology of Blood and Marrow Transplantation. 2019;25(4):625-638. doi:10.1016/j.bbmt.2018.12.758.
