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irAE Cranial Neuropathy — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyirAE Cranial NeuropathySCE Medical Oncology

A 55-year-old woman on ICI develops a new facial droop and dysarthria. CT head is normal. MRI brain shows gadolinium enhancement of the left facial nerve. What neurological irAE should be considered?

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Correct answer: B — Immune-related cranial neuropathy (facial nerve palsy/Bell's palsy equivalent) — hold ICI, start prednisolone 1 mg/kg, neurology review

ICI-related cranial neuropathies (most commonly facial nerve) present similarly to idiopathic Bell's palsy but in the context of ICI therapy should be presumed immune-mediated. MRI showing facial nerve enhancement supports the diagnosis. Management: ICI hold, prednisolone 1 mg/kg with slow taper, and neurology review. Bilateral facial palsy or multiple cranial nerve palsies should prompt CSF analysis to exclude leptomeningeal disease or Guillain-Barré syndrome. Most cases resolve with corticosteroid treatment.

Reference: ESMO 2024 irAE Management; Guidon et al JAMA Neurol 2021