What are the symptoms of ICANS? 

The symptoms of ICANS can vary depending on their grade of severity. Mild symptoms include confusion, headaches, fatigue, and trouble communicating. Severe and potentially life-threatening side effects can include seizures, raised intracranial pressure with cerebral edema (swelling of the brain), and coma. 

How are ICANS symptoms classified and treated?

ICANS symptoms can be measured on a grading level from 1-4 to determine their severity. 

Grade 1

Patients should be closely monitored and receive supportive measures if needed. Symptoms in Grade 1 include extreme fatigue. Patients at this stage will awaken spontaneously.

Management in this stage includes: 

• Supportive care 
• IV hydration
• Consider antiepileptic (anti-seizure) drug 

Grade 2

Symptoms in Grade 2 include deliriousness or abnormal drowsiness. Patients will only awaken to voices at this stage. 

Management reactions in this stage include: 

• Supportive care included in Grade 1 ICANS management 
• Neurology consultation (bizarre questions asked to assess awareness/consistency) 
• Imaging tests like EEG (electroencephalogram/brain scan) or MRI (magnetic resonance imaging)
• Consider an antiepileptic (anti-seizure) drug, if not already started 
• Low-dose corticosteroids (i.e. dexamethasone 10mg) 

Grade 3 

Symptoms in Grade 3 include edema (sweling by fluid buildup) and/or seizures that resolve with intervention. Patients at this stage will only awaken to tactile stimuli. 

Management reactions in this stage include: 

• Supportive care included in Grade 2 ICANS management 
• An ICU transfer 
• Continuous corticosteroids (i.e. dexamethasone 10 mg every 6 hours) 
• Continuous antiepileptic (anti-seizure) drugs 
• Imaging tests for monitoring  

Grade 4

Symptoms in Grade 4 include coma, cerebral edema, life-threatening seizures (>5 minutes), and/or muscle weakness. Patients at this stage are unresponsive. 

Management reactions in this stage include: 

• Supportive care included in Grade 3 ICANS management 
• High-dose corticosteroids 
• Specific neurointensive treatment (status epilepticus, brain edema) 
• Consider further individual treatment