Changes of a Cerebral Cavernous Malformation Associated With Lecanemab Therapy in a Patient With Alzheimer Disease.

IF 2.3 Q3 CLINICAL NEUROLOGY

Neurology. Clinical practice Pub Date : 2025-08-01 Epub Date: 2025-06-18 DOI:10.1212/CPJ.0000000000200508

Nicholas U Schwartz, Connor D Dietz, Igor Prufer Araújo, Javier E Villanueva-Meyer, Winston Chiong, Courtney Lane-Donovan, Lawren Vandevrede, Peter A Ljubenkov, Yingbing Wang, David N Soleimani-Meigooni, Renaud La Joie, Julio C Rojas

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引用次数: 0

Abstract

Background and objectives: Antiamyloid immunotherapies are associated with increased risk of intracerebral hemorrhage, particularly in the setting of APOE-ε4 carriership, anticoagulation, thrombolytics, and other lesions at risk of hemorrhagic conversion. It is not known whether patients with cavernous malformations are at increased risk of complication because patients with these lesions were excluded from clinical trials.

Methods: We describe a case of a patient with Alzheimer disease (AD) with an incidental cavernous malformation treated with lecanemab.

Results: A 73-year-old APOE ε4 heterozygous woman with mild cognitive impairment and CSF biomarker evidence of AD underwent treatment with intravenous lecanemab. Baseline MRI revealed 3 lobar microhemorrhages and an asymptomatic left orbitofrontal cavernous malformation. This cavernous malformation exhibited gross radiologic stability at surveillance brain MRI before the 5th and 7th infusions, but on surveillance MRI after infusion 13 exhibited an asymptomatic increase in size with subacute blood products without additional new amyloid-related imaging abnormalities (ARIA), resulting in treatment discontinuation.

Discussion: Lecanemab therapy was associated with asymptomatic expansion of an incidental cavernous malformation in a patient with AD and without evidence of ARIA.

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莱卡耐单抗治疗阿尔茨海默病患者脑海绵状血管瘤的改变

背景和目的：抗淀粉样蛋白免疫治疗与脑出血风险增加有关，特别是在APOE-ε4携带者、抗凝、溶栓和其他有出血转化风险的病变的情况下。由于海绵体畸形患者被排除在临床试验之外，因此尚不清楚海绵体畸形患者是否有更高的并发症风险。方法：我们描述了一例患者阿尔茨海默病（AD）与偶发海绵状血管瘤治疗莱卡耐单抗。结果：一名73岁APOE ε4杂合女性，轻度认知障碍，脑脊液生物标志物证据为AD，接受静脉注射莱卡耐单抗治疗。基线MRI显示3个大叶微出血和一个无症状的左眶额海绵状血管瘤。在第5次和第7次输注前，监测MRI显示海绵状畸形的放射学大体稳定，但在输注13次后的监测MRI显示，亚急性血液制品尺寸无症状增加，没有额外的新的淀粉样蛋白相关成像异常（ARIA），导致治疗停止。讨论：莱卡耐单抗治疗与AD患者偶发海绵体畸形的无症状扩张相关，且无ARIA证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology. Clinical practice CLINICAL NEUROLOGY-

CiteScore

4.00

自引率

0.00%

发文量

期刊介绍： Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.