Primary CNS lymphoma with raised intracranial pressure / mass effect at presentation: foc...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-PCNSL-INTRACRANIAL-PRESSURE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-PCNSL`
Sources	`SRC-NCCN-BCELL-2025` `SRC-NCCN-CNS-2025`

Red Flag Origin

Definition	Primary CNS lymphoma with raised intracranial pressure / mass effect at presentation: focal deficit, headache + papilledema, obtundation, midline shift on imaging, herniation risk
Clinical direction	hold
Category	organ-dysfunction
Shifts algorithm	ALGO-PCNSL-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "raised_intracranial_pressure",
      "value": true
    },
    {
      "comparator": ">",
      "finding": "midline_shift_mm",
      "threshold": 5
    },
    {
      "finding": "papilledema",
      "value": true
    },
    {
      "comparator": "<",
      "finding": "gcs_score",
      "threshold": 12
    },
    {
      "finding": "herniation_risk",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

PCNSL frequently presents with raised ICP; 60-70% have focal deficit at diagnosis. Per NCCN-CNS PCNSL section: dexamethasone 16 mg/day initial dose markedly reduces tumor (steroid-responsive); however steroids must be HELD before stereotactic biopsy if biopsy is diagnostic-pending — steroids alone can produce tissue regression precluding histology. Direction HOLD on definitive HD-MTX-based induction until ICP managed AND biopsy obtained. Priority 10. STUB — requires clinical co-lead signoff.

Used By

No reverse references found in the YAML corpus.