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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
PubMed

Insights

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.
Keywords:
ARIAAlzheimer’s diseaseLecanemabamyloidstroke

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