Open AccessSymptomatic amyloid‐related imaging abnormalities in an APOE ε4/ε4 patient treated with aducanumab
Author(s) -
VandeVrede Lawren,
Gibbs Daniel M,
Koestler Mary,
La Joie Renaud,
Ljubenkov Peter A.,
Provost Karine,
SoleimaniMeigooni David,
Strom Amelia,
Tsoy Elena,
Rabinovici Gil D.,
Boxer Adam L.
Publication year - 2020
Publication title -
alzheimer's and dementia: diagnosis, assessment and disease monitoring
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.497
H-Index - 37
ISSN - 2352-8729
DOI - 10.1002/dad2.12101
Subject(s) - medicine , apolipoprotein e , magnetic resonance imaging , positron emission tomography , pittsburgh compound b , amyloid (mycology) , cerebral amyloid angiopathy , pathophysiology , encephalopathy , neuroimaging , pathology , nuclear medicine , radiology , dementia , disease , psychiatry
Amyloid‐related imaging abnormalities (ARIA) are a common, dose‐dependent effect of amyloid‐targeting antibodies, strongly associated with the apolipoprotein E (APOE) ε4 allele. Methods We describe the clinical course and management of a 66‐year‐old white male (APOE ε4/ε4) enrolled in an observational study that included amyloid and tau positron emission tomography (PET), who received aducanumab through the ENGAGE clinical trial. Results Acute symptoms included headache and encephalopathy, and magnetic resonance imaging revealed ARIA‐E and ARIA‐H. Malignant hypertension and epileptiform activity were treated with nicardipine and levetiracetam. Subsequent clinical/imaging worsening prompted a course of methylprednisolone. Symptoms and ARIA‐E resolved over 6 months, while ARIA‐H persisted. Quantitative analysis of interval amyloid PET showed reduced signal in pre‐existing areas but increased signal posteriorly; while tau PET showed increased signal overall. Discussion In an APOE ε4/ε4 patient, ARIA symptoms were accompanied by malignant hypertension and epileptiform activity, and pulsed steroids reversed edema. Studies from larger cohorts may clarify the optimal treatment and pathophysiology of ARIA.