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Acute Neurologic Decline in the ED: A Case Report on Recognizing ARIA in the Age of Anti-Amyloid Therapy
Blanton C, Hines J, Ginsburg J, Parnell S.. Journal of education & teaching in emergency medicine, 2026-10-31
Topic: Amyloid, tau and blood-test diagnosis
Anti-amyloid beta (Aβ) immunotherapies are an emerging treatment for Alzheimer's disease (AD) with a rare but significant risk of amyloid-related imaging abnormalities (ARIA). This visual case report describes a patient with lecanemab-induced ARIA to familiarize emergency providers with this critical adverse effect of novel anti-amyloid therapies. An 85-year-old female receiving lecanemab infusions presented to the emergency department (ED) with abruptly worsening confusion, an unsteady gait, and new left-sided deficits, including homonymous hemianopia and hemineglect. A non-contrast head computed tomography (CT) revealed extensive right parieto-occipital vasogenic edema, prompting magnetic resonance imaging (MRI), which confirmed extensive ARIA with edema (ARIA-E) on fluid-attenuated inversion recovery (FLAIR) sequences and microhemorrhages (ARIA-H) on T2-weighted sequences. Lecanemab was discontinued, and the patient experienced partial neurologic recovery after a four-day admission. However, she was discharged with persistent functional limitations, including an inability to drive and a need for caregiver assistance. This case underscores the need for emergency physicians to maintain a high index of suspicion for ARIA in patients on anti-Aβ immunotherapies who present with new neurologic symptoms. Definitive diagnosis requires MRI, and management warrants prompt neurologic consultation. Topics Alzheimer's, dementia, neurology, medication adverse effects, ARIA.
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APA 7th
Blanton, C., Hines, J., Ginsburg, J., & Parnell, S. (2026). Acute Neurologic Decline in the ED: A Case Report on Recognizing ARIA in the Age of Anti-Amyloid Therapy. Journal of education & teaching in emergency medicine. https://doi.org/10.5070/m5.61894
Vancouver
Blanton C, Hines J, Ginsburg J, Parnell S. Acute Neurologic Decline in the ED: A Case Report on Recognizing ARIA in the Age of Anti-Amyloid Therapy. Journal of education & teaching in emergency medicine. 2026. doi:10.5070/m5.61894. PMID: 43011928.
BibTeX
@article{blanton2026-43011928,
author = {Blanton, C. and Hines, J. and Ginsburg, J. and Parnell, S.},
title = {{Acute Neurologic Decline in the ED: A Case Report on Recognizing ARIA in the Age of Anti-Amyloid Therapy}},
journal = {Journal of education \& teaching in emergency medicine},
year = {2026},
doi = {10.5070/m5.61894},
pmid = {43011928},
url = {https://doi.org/10.5070/m5.61894}
}
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Key findings
- Anti-amyloid beta (Aβ) immunotherapies are an emerging treatment for Alzheimer's disease (AD) with a rare but significant risk of amyloid-related imaging abnormalities (ARIA).
- A non-contrast head computed tomography (CT) revealed extensive right parieto-occipital vasogenic edema, prompting magnetic resonance imaging (MRI), which confirmed extensive ARIA with edema (ARIA-E) on fluid-attenuated inversion recovery (FLAIR) sequences and microhemorrhages (ARIA-H) on T2-weighted sequences.
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Study details
- Study designcase report
- Evidence strengthLow
How this study scored 43/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 25 of the 58 points we could judge it on, which is 43 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of education & teaching in emergency medicine) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 0 / 12 | Design recorded as “case report”, which our rubric does not rank (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 43011928) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 25 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 25 of the 58 points we could judge it on is 43 out of 100. |
| Total | 43 / 100 | — |
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