Table 4 ICE score, ASTCT grading systems of ICANS and management of ICANS

Orientation

Orientation to year, month, city, hospital: 4 points

Naming

Ability to name 3 objects (e.g., point to clock, pen, button): 3 points

Following commands

Ability to follow simple commands (e.g., “Show me 2 fingers” or “Close your eyes and stick out your tongue”): 1 point

Writing

Ability to write a standard sentence (e.g., “Our national bird is the bald eagle”): 1 point

Attention

Ability to count backward from 100 by 10: 1 point

Scoring: 10, no impairment;

7–9, grade 1 ICANS;

3–6, grade 2 ICANS;

0–2, grade 3 ICANS;

0 due to the unarousable patient and unable to perform ICE assessment, grade 4 ICANS

Items

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

ICE score

7–9

3–6

0–2

0 (unarousable patient and unable to perform ICE assessment)

Death

Depressed level of consciousness

Awakens spontaneously

Awakes to voice

Awakens only to tactile stimulus

The patient is unarousable or requires vigorous or repetitive tactile stimuli to arouse. Stupor or coma

Death

Seizure

N/A

N/A

Any clinical seizure focal or generalized that resolves rapidly or nonconvulsive seizures on EEG that resolve with intervention

Life-threatening prolonged seizure (> 5 min); or Repetitive clinical or electrical seizures without return to baseline in between

Death

Motor findings

N/A

N/A

N/A

Deep focal motor weakness such as hemiparesis or paraparesis

Death

Elevated ICP/cerebral edema

N/A

N/A

Focal/local edema on neuroimaging

Diffuse cerebral edema on neuroimaging; decerebrate or decorticate posturing; or cranial nerve VI palsy; or papilledema; or Cushing's triad

Death

Grade

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Recommended management

Supportive management

Consider corticosteroid use (≤ 10 days)

Corticosteroid use (≤ 10 days)

Corticosteroid use (≤ 10 days)

N/A