Neurotoxicity domain | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
ICE score* | 7 to 9 | 3 to 6 | 0 to 2 | 0 (patient is unarousable and unable to perform ICE) |
Depressed level of consciousness¶ | Awakens spontaneously | Awakens to voice | Awakens only to tactile stimulus | Patient is unarousable or requires vigorous or repetitive tactile stimuli to arouse; stupor or coma |
Seizure | N/A | N/A | Any clinical seizure, focal or generalized, that resolves rapidly, or nonconvulsive seizures on EEG that resolve with intervention | Life-threatening prolonged seizure (>5 minutes), or repetitive clinical or electrical seizures without return to baseline in between |
Motor findingsΔ | N/A | N/A | N/A | Deep focal motor weakness such as hemiparesis or paraparesis |
Elevated ICP/cerebral edema | N/A | N/A | Focal/local edema on neuroimaging◊ | Diffuse cerebral edema on neuroimaging, decerebrate or decorticate posturing, cranial nerve VI palsy, papilledema, or Cushing triad |
ICE score definitions | ||||
Orientation | Orientation to year, month, city, hospital | 4 points | ||
Naming | Ability to name 3 objects (eg, point to clock, pen, button) | 3 points | ||
Following commands | Ability to follow simple commands (eg, "Show me 2 fingers" or "Close your eyes and stick out your tongue") | 1 point | ||
Writing | Ability to write a standard sentence (eg, "Our national bird is the bald eagle") | 1 point | ||
Attention | Ability to count backwards from 100 by 10 | 1 point |
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