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. 2021 Mar 29;8(4):968–979. doi: 10.1002/acn3.51348

Table 2.

Proposed criteria for cytokine storm‐associated encephalopathy (CySE).

Encephalopathy
  • Acute or subacute onset

  • Severity ranging from mildly altered mental status to coma

  • Common manifestations include: delirium, language disturbances, seizures, and dysexecutive syndrome

Association with cytokine storm 1

Cytokine storm criteria proposed by Fajgenbaum et al. 1

  • Elevated circulating cytokine levels

  • Acute systemic inflammatory symptoms

  • Secondary organ dysfunction 2 beyond that which could be attributed to a pathogen, if a pathogen is present

Exclusion of other causes 3

Including, but not limited to:

  • Metabolic disturbances

  • Definite infectious brain disease

  • Autoantibody‐mediated brain disease

Supportive findings
  • CSF analysis: absence of marked pleocytosis, elevated cytokine CSF/serum ratio

  • EEG: frontal predominant abnormalities

  • Brain MRI 4 : diffuse microbleeds, cortical diffusion restriction, and leptomeningeal enhancement; T2/FLAIR hyperintensities of the splenium of the corpus callosum, thalami, or claustrum; PRES‐like findings

  • FDG‐PET/MRI perfusion: frontal predominant hypometabolism/hypoperfusion

  • Response to immunotherapies

1

Cytokine storm may occur concomitantly or precede neurological manifestations.

2

This may include brain dysfunction.

3

The presence of one or more concomitant conditions potentially contributing to encephalopathy should not be considered as an absolute exclusion criteria if these are not sufficient to account for clinical severity.

4

Most of the patients present with unrevealing neuroradiological examinations. It is confounding to use number for references and notes in the same table. Would it be possibles to use letters for table notes?