From the Guidelines
Central nervous system (CNS) symptoms include headache, confusion, memory problems, seizures, tremors, loss of consciousness, altered mental status, visual disturbances, speech difficulties, coordination problems, weakness or paralysis, numbness or tingling sensations, sleep disturbances, mood changes, hallucinations, and changes in personality. These symptoms can result from various conditions, including infections, trauma, stroke, tumors, neurodegenerative diseases, toxic exposures, or metabolic disorders 1. Some key CNS symptoms to consider are:
- Headache
- Confusion
- Memory problems
- Seizures
- Tremors
- Loss of consciousness
- Altered mental status
- Visual disturbances
- Speech difficulties
- Coordination problems
- Weakness or paralysis
- Numbness or tingling sensations
- Sleep disturbances
- Mood changes
- Hallucinations
- Changes in personality It's essential to note that the specific pattern and severity of symptoms can help clinicians localize the problem within the CNS, and early recognition of CNS symptoms is crucial for prompt intervention to prevent permanent damage 1. Additionally, CNS symptoms can be associated with immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitor therapy, which can include myasthenia gravis, aseptic meningitis, encephalitis, sensory motor neuropathy, and Guillain-Barré-like syndromes 1. In patients presenting with CNS symptoms, it's crucial to rule out CNS progression of cancer, seizure activity, infection, and metabolic derangement as causes of neurologic symptoms, and consultation with a neurologist is advised for all neurologic irAEs grade 2 or higher 1.
From the FDA Drug Label
Paradoxical excitation was observed in 10% to 30% of the pediatric patients under 8 years of age and was characterized by tremors, agitation, euphoria, logorrhea, and brief episodes of visual hallucinations. The “gasping syndrome”, (characterized by central nervous system depression, metabolic acidosis, gasping respirations, and high levels of benzyl alcohol and its metabolites found in the blood and urine) has been associated with benzyl alcohol dosages greater than 99 mg/kg/day in neonates and low-birth-weight neonates Additional symptoms may include gradual neurological deterioration, seizures, intracranial hemorrhage, hematologic abnormalities, skin breakdown, hepatic and renal failure, hypotension, bradycardia, and cardiovascular collapse Central nervous system toxicity, including seizures and intraventricular hemorrhage, as well as unresponsiveness, tachypnea, tachycardia, and diaphoresis have been associated with propylene glycol toxicity Clinical studies of lorazepam generally were not adequate to determine whether subjects aged 65 and over respond differently than younger subjects; however, age over 65 may be associated with a greater incidence of central nervous system depression and more respiratory depression
The list of CNS symptoms includes:
- Tremors
- Agitation
- Euphoria
- Logorrhea
- Visual hallucinations
- Central nervous system depression
- Seizures
- Intracranial hemorrhage
- Intraventricular hemorrhage
- Gradual neurological deterioration
- Unresponsiveness 2
From the Research
CNS Symptoms
The following are some common CNS symptoms:
- Seizures 3, 4, 5, 6
- Confusion 3, 6
- Encephalopathy-related cognitive and affective abnormalities 6
- Headaches 6
- Multifocal symptoms associated with recurrent episodes of ischemia or hemorrhage 6
- Spinal cord lesions 6
- Status epilepticus (SE) 3, 4
- Acute encephalitis 5
- Bacterial meningitis 5
- Traumatic brain injury (TBI) 7
- Traumatic spinal cord injury (SCI) 7
Specific Conditions
Some specific conditions that may cause CNS symptoms include:
- Convulsive status epilepticus (CSE) 4
- Nonconvulsive SE 3
- Epilepsia partialis continua (EPC) 3
- Primary angiitis of the central nervous system (PACNS) 6
- Reversible cerebral vasoconstriction syndrome 6
- Cerebral involvement of systemic vasculitides or rheumatic diseases 6
- Moyamoya angiopathy 6
- Infectious vasculopathies 6