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In a multicenter prospective study, Antolini et al.1 offered critical information on the natural history and treatment outcomes of spontaneous amyloid-related imaging abnormality (ARIA)–like events in a large cohort of inpatients diagnosed with cerebral amyloid angiopathy–related inflammation (CAA-ri). We appreciate the authors' comments on the overlap in neuroradiologic features and main pathogenic contributors to both ARIA and ARIA-like events. Considering the yet unanswered issues regarding the management of drug-induced ARIAs in a real-world setting,2 this study provides reasonable indications. Because only anecdotal evidence has suggested the use of corticosteroids to facilitate resolution of symptomatic extensive ARIAs,3 here, the authors suggested that intravenous corticosteroid pulse therapy, followed by slow oral tapering might guarantee better long-term outcomes. Moreover, natural β-amyloid–targeting autoantibodies in the CSF, which characterize CAA-ri (with or without co-occurrent AD),4 may meet the specific requirement of biomarkers to assess the individual risk for ARIA development. Therefore, monitoring levels of β-amyloid–targeting antibodies, both therapeutically administered and naturally produced, can be suggested as a strategy to tailor treatment individually, maintaining a “therapeutic window” for the safe clearance of β-amyloid through vascular spaces and minimizing the occurrence of ARIAs.5
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- Received August 19, 2022.
- Accepted in final form August 19, 2022.
- © 2022 American Academy of Neurology
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