Table 2.

Grading Scale for Tumor Inflammation-Associated Neurotoxicity

Grade	Definition
1	Headache with fever OR mild worsening from the baseline neurological function with only supportive symptomatic management required.
2	Moderate neurological changes from baseline that substantially affect function
3	Severe neurological clinical signs and symptoms that may affect critical cardiorespiratory functions. OR clinical signs and symptoms of increased intracranial pressure (>20 mmHg) that are responsive to intervention
4	Life-threatening, clinically significant elevated ICP (>20 mmHg) refractory to CSF drainage with no improvement in clinical symptoms in response to CSF drainage, possibly warranting urgent escalation of neurosurgical intervention (such as with emergent EVD or VPS placement) OR concerning clinical signs and symptoms of impending/early herniation OR severe medullary dysfunction requiring endotracheal intubation for airway protection and/or mechanical ventilation

^*Adapted from Mahdi J, Dietrich J, Straathof K, et al. Tumor inflammation-associated neurotoxicity. Nat Med. 2023;29(4):803-810. doi:10.1038/s41591-023-02276-w⁸ Used with permission.

Abbreviations: ICP, intracranial pressure; CSF, cerebrospinal fluid; EVD, extraventricular drain; VPS, ventriculoperitoneal shunt.