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Multiple ischemic strokes in a patient treated with Lecanemab: a case report
Hajar Alammar1,2, Mamadou Diallo1,2, Daniel A Llano1,2,3,4
1Carle Neuroscience Institute, Urbana, IL, USA.
Neurocase
|October 17, 2025
Summary
Amyloid-lowering therapy for Alzheimer's Disease may increase risk of both bleeding (ARIA-H) and ischemic stroke. This case study highlights potential vascular risks associated with Lecanemab treatment.
Area of Science:
- Neurology
- Pharmacology
- Neuroimaging
Background:
- Amyloid-lowering therapies, including monoclonal antibodies targeting amyloid beta, are emerging treatments for Alzheimer's Disease.
- These therapies have been linked to amyloid-related imaging abnormalities (ARIA), such as cerebral edema (ARIA-E) and microhemorrhage (ARIA-H).
- Ischemic events have been anecdotally reported but not systematically studied in relation to these therapies.
Purpose of the Study:
- To report a case of a patient with Alzheimer's Disease experiencing both ARIA and ischemic infarctions during Lecanemab treatment.
- To investigate the potential association between amyloid-lowering therapy and ischemic events.
Main Methods:
- Case report of an Alzheimer's Disease patient treated with Lecanemab.
- Monitoring for amyloid-related imaging abnormalities (ARIA-E and ARIA-H) via MRI.
- Comprehensive diagnostic workup to identify causes of ischemic infarction.
- Review of existing literature on anti-amyloid therapy and ischemic events.
Main Results:
- The patient developed both ARIA-H and ARIA-E during Lecanemab treatment.
- Multiple asymptomatic ischemic infarctions were detected on MRI.
- No alternative cause for the ischemic infarctions was identified during the workup.
- The findings align with previous case reports of ischemic infarction during anti-amyloid therapy.
Conclusions:
- Amyloid-lowering therapy, exemplified by Lecanemab, may increase the risk of ischemic infarction in addition to ARIA.
- The study suggests a potential predisposition to both hemorrhagic and ischemic vascular events.
- Underlying microvascular pathology in Alzheimer's Disease may contribute to these treatment-related risks.
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