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Case Reports
. 2024 Nov;20(11):8192-8197.
doi: 10.1002/alz.14223. Epub 2024 Aug 30.

Ischemic stroke associated with amyloid-related imaging abnormalities in a patient treated with lecanemab

Alec W Gibson  1 , Holly Elser  1 , Michela Rosso  1 , Eli J Cornblath  1 , Yombe Fonkeu  1 , Sashank Prasad  1 , Aaron Rothstein  1 , Ilya M Nasrallah  2 , David A Wolk  1 , Michael H Guo  1
Affiliations
Case Reports

Ischemic stroke associated with amyloid-related imaging abnormalities in a patient treated with lecanemab

Alec W Gibson et al. Alzheimers Dement. 2024 Nov.

Abstract

Introduction: Anti-amyloid antibody therapies such as lecanemab are increasingly being used to treat Alzheimer's disease (AD). These therapies are associated with a high rate of amyloid-related imaging abnormalities (ARIA).

Methods: We review the case history of a patient who developed ARIA associated with lecanemab treatment.

Results: In addition to microhemorrhages and cerebral edema that are recognized features of ARIA, the patient developed several ischemic strokes. The patient also experienced frequent electrographic seizures without overt clinical seizures. The patient demonstrated clinical and radiographic improvement after steroid treatment.

Discussion: Our case suggests that ischemic strokes may be a feature of ARIA and highlights the importance of having a high clinical suspicion for seizures in ARIA. As anti-amyloid therapies are likely going to be increasingly used to treat AD, it is important to appreciate the spectrum of clinical and radiographic findings that can result as side effects from this class of therapies.

Highlights: We report a patient who developed severe amyloid-related imaging abnormalities (ARIA) after treatment with lecanemab. Our report suggests that ischemic strokes may be a novel imaging feature of ARIA. Our report highlights the need for high clinical suspicion for seizures in ARIA.

Keywords: Alzheimer's disease; amyloid; lecanemab; seizure; stroke.

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Conflict of interest statement

D.A.W serves as a paid consultant to Eli Lilly and has previously served as a paid consultant to GE Healthcare and Qynapse. He serves on a data safety monitoring board (DSMB) for Functional Neuromodulation and GSK. He receives research support paid to his institution from Biogen. I.N. has served as a paid consultant for Eisai and does educational speaking for PeerView. All other authors report no competing interests. Author disclosures are available in the supporting information.

Figures

FIGURE 1
FIGURE 1
Baseline magnetic resonance imaging. A, Coronal T2‐weighted images showing mild hippocampal atrophy and prominent perivascular spaces. B, Axial susceptibility‐weighted images showing three microhemorrhages seen at baseline prior to lecanemab treatment. Microhemorrhages indicated by red arrows.
FIGURE 2
FIGURE 2
Magnetic resonance imaging at initial presentation for amyloid‐related imaging abnormalities (ARIA). A, Axial T2/fluid‐attenuated inversion recovery sequence showing edema in the right more than left temporal, parietal, and occipital lobes consistent with ARIA edema. B, Coronal T1 sequences after gadolinium administration showing leptomeningeal enhancement in the areas of edema. C, New microhemorrhage not present at baseline, as indicated by white arrow. D, Area of diffusion restriction (white arrow) in the right occipital lobe on diffusion‐weighted imaging. E, Apparent diffusion coefficient (ADC) map showing reduced ADC signal in the area of diffusion restriction.
FIGURE 3
FIGURE 3
Follow‐up imaging hospital discharge. A) T2/fluid‐attenuated inversion recovery (FLAIR) showing resolving edema at 1 month after hospital discharge. B, New punctate area of diffusion restriction on diffusion‐weighted imaging (white arrow) at 1 month after hospital discharge. C, T2/FLAIR showing essentially resolved edema at 5 months after hospital discharge. D, Axial susceptibility‐weighted images at 5 months after hospital discharge showing several microhemorrhages that had developed in the preceding months. Microhemorrhages present prior to lecanemab treatment are indicated by white arrows. Microhemorrhages that developed in the intervening few months are indicated by asterisks.
See this image and copyright information in PMC

References

    1. 2023 Alzheimer's disease facts and figures. Alzheimers Dement. 2023;19(4):1598‐1695. - PubMed
    1. Selkoe DJ, Hardy J. The amyloid hypothesis of Alzheimer's disease at 25 years. EMBO Mol Med. 2016;8(6):595‐608. - PMC - PubMed
    1. Karran E, Mercken M, De Strooper B. The amyloid cascade hypothesis for Alzheimer's disease: an appraisal for the development of therapeutics. Nat Rev Drug Discov. 2011;10(9):698‐712. - PubMed
    1. Sevigny J, Chiao P, Bussière T, et al. The antibody aducanumab reduces Aβ plaques in Alzheimer's disease. Nature. 2016;537(7618):50‐56. - PubMed
    1. van Dyck CH, Swanson CJ, Aisen P, et al. Lecanemab in early Alzheimer's disease. N Engl J Med. 2022;388(1):9‐21. - PubMed

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