Test your knowledge of neurologic toxicity following CAR T-cell therapy in patients with primary central nervous system lymphoma

A patient with primary CNS lymphoma develops a new ICE score of 0/10 after CAR T-cell therapy, but CT imaging shows stable hydrocephalus. Which diagnosis is most concerning?
Grade 3 ICANS
Uncomplicated hydrocephalus
Chemotherapy toxicity
Grade 1 CRS
Why can distinguishing ICANS from TIAN be particularly challenging in a patient receiving CAR T-cell therapy for primary CNS lymphoma?
TIAN occurs only before CAR-T infusion
Both can present with overlapping neurologic symptoms
ICANS occurs only in patients with CNS disease
Neither condition can cause encephalopathy
When severe immune-mediated neurotoxicity is suspected after CAR T-cell therapy, what is the key immediate treatment principle?
Administer tocilizumab alone
Avoid corticosteroids to preserve CAR-T efficacy
Wait for cytokine panel results
Prompt initiation of high-dose corticosteroids
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