Encephalitis/Meningoencephalitis Post Immune Checkpoint Inhibitor Therapy

Immune check point inhibitors encephalitis can involve focal (limbic) encephalitis that predominantly involving temporal lobes or extra-limbic encephalitis. Patients can present with working memory deficits, seizures, psychiatric symptoms, and depending on the brain regions involved have various focal neurological symptoms. Work up includes hospital or ICU admission, rapid evaluation, and neurology consultation. Neuroimaging, EEG, spinal fluid analysis is urgently needed. Work up should exclude oncological recurrence, including carcinomatosis meningitis, infections and other treatable etiologies like vitamin deficiencies. Treatment includes holding further check point therapy. Immunosuppressives are generally needed including multimodality approach as well. Seizures shoud be promptly and aggressively treated. ICI encephalitis can be associated with poor outcomes and providers should inform, engage and guide family members from the beginning.