Amyloid-related imaging abnormalities (ARIA)

Case contributed by Rodrigo Dias Duarte
Diagnosis certain


Mild Alzheimer`s disease patient who was being treated with Aducanumab. Sudden onset of confusion and headaches.

Patient Data

Age: 80 years.
Gender: Female

CASE OF THE MONTH: This case was selected as the Case of the Month for September 2022.

Multiple cortical and subcortical areas of vasogenic edema in both cerebral hemispheres, more extensive in the temporal lobes, with some hyperintense sulci on FLAIR images, consistent with sulcal effusions.

SWI sequence shows subcortical microbleeds, more evident in the temporal lobes.

There are no areas of restriction on DWI or pathologic enhancement in the post-contrast sequences.

Case Discussion

Amyloid-related imaging abnormalities (ARIA) are associated with amyloid-modifying therapies, particularly human monoclonal antibodies such as aducanumab, in patients with Alzheimer's disease.

ARIA can manifest as brain edema or sulcal effusion (ARIA-E) or parenchymal microhemorrhages and superficial siderosis (ARIA-H).

ARIA-E usually resolves over weeks or months, whereas ARIA-H can remain present permanently.

The imaging findings are very similar to inflammatory cerebral amyloid angiopathy. PRES is also an important differential diagnosis. The clinical context is crucial for the correct diagnosis.

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