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Post-stroke seizures — SCE Neurology MCQ

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HardEpilepsyPost-stroke seizuresSCE Neurology

Ten days after nivolumab, a patient develops ptosis, neck weakness and dyspnoea with CK 4,200 IU/L, troponin 1,600 ng/L and new complete heart block. Which initial plan best addresses this checkpoint-inhibitor overlap syndrome?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Withhold nivolumab and give corticosteroids plus early IVIg or plasma exchange with cardiac monitoring

Explanation lettering: D = shown as B · B = shown as C · C = shown as D

A ignores the myositis and myocarditis signals and dangerously continues the trigger. B omits corticosteroids, the foundation of treatment for the triple myasthenia–myositis–myocarditis syndrome. C delays disease-directed therapy despite respiratory and cardiac risk. D treats one electrical complication but not the immune process; pacing decisions require cardio-oncology input. E is correct: withhold the checkpoint inhibitor, start high-dose corticosteroids, add early IVIg or plasma exchange for significant myasthenia, and monitor rhythm, ventricular function and respiratory status closely.

Reference: Neurological complications of immune checkpoint inhibitors: a practical guide: https://pn.bmj.com/content/25/2/116