{
    "abstract": "Patients with Alzheimer's disease who have been given monoclonal antibodies targeting amyloid-\u03b2 (A\u03b2) (eg, gantenerumab, donanemab, lecanemab, and aducanumab) for scientific purposes may have a spectrum of imaging findings known as amyloid-related imaging abnormalities (ARIA), shown on brain magnetic resonance imaging (MRI) scans. These neuroimaging abnormalities are caused by antibody-mediated destruction of accumulated A\u03b2 aggregates in cerebral blood vessels and brain parenchyma. ARIA may demonstrate as brain edema or sulcal effusion (ARIA-E) or as hemosiderin deposits caused by brain parenchymal or pial hemorrhage (ARIA-H). The current study explores 2 cases with interval development of FLAIR hyper signal intensity along the bilateral corticospinal tracts in the motor cortex/precentral gyri after treatment by aducanumab. We believe this manifestation is a subtype of ARIA-A that has not been explored earlier. Our first case was a 72-year-old woman with a history of HTN and kidney transplant (polycystic kidney) who presented with mild cognitive impairment with clinical findings consistent with early Alzheimer's disease. After receiving 3 doses of aducunumab and experiencing cognition improvement, she underwent a brain MRI because of dizziness and vertigo. The brain MRI demonstrated new FLAIR hyper signal intensity in subcortical regions of precentral gyri (motor cortex) symmetrically as well as trace subarachnoid hemorrhage at the vertex compatible with ARIA-E and ARIA-H. Our second case was an 85-year-old woman with a history of small lymphocytic leukemia which was treated 20 years earlier. After orthopedic surgery 2 years ago, she developed dementia with anterograde amnesia. Since then, Aricept and Namenda have been started, but there have been no improvements in her subjective condition. The initial Amyloid PET/MR imaging showed diffuse cerebral Amyloid deposition. After tolerating 6 doses of aducanumab a safety MRI revealed new bilateral symmetric FLAIR hyper signal intensity in the subcortical motor cortex. Results of our study suggest that the subcortical corticospinal tract is another hotspot for ARIA findings. Hence, these regions might be an unknown site for both the action and adverse effects of aducanumab on amyloid plaques with secondary inflammation. In addition, radiologists must take this phenomenon into the account, and be cognizant that the FLAIR hyper signal intensities should not be misinterpreted as motor neuron disease (eg, amyotrophic lateral sclerosis).",
    "authors": [
        {
            "affiliation": "Department of Radiology and Neurology, University of Alabama at Birmingham (UAB), JTN 333, 619 19th St S, Birmingham, AL 35294, USA.",
            "firstname": "Houman",
            "initials": "H",
            "lastname": "Sotoudeh"
        },
        {
            "affiliation": "Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.",
            "firstname": "Mohammadreza",
            "initials": "M",
            "lastname": "Alizadeh"
        },
        {
            "affiliation": "School of Medicine, Bushehr university of medical sciences, Bushehr, Iran.",
            "firstname": "Ramin",
            "initials": "R",
            "lastname": "Shahidi"
        },
        {
            "affiliation": "School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.",
            "firstname": "Parnian",
            "initials": "P",
            "lastname": "Shobeiri"
        },
        {
            "affiliation": "Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.",
            "firstname": "Natelson",
            "initials": "N",
            "lastname": "Love"
        },
        {
            "affiliation": "Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.",
            "firstname": "Aparna",
            "initials": "A",
            "lastname": "Singhal"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.",
    "doi": "10.1016/j.radcr.2022.10.023",
    "journal": "Radiology case reports",
    "keywords": [
        "AD, Alzheimer's disease",
        "ARIA, amyloid-related imaging abnormalities",
        "Alzheimer Disease",
        "Amyloid-related imaging abnormalities",
        "A\u03b2, amyloid-beta peptide",
        "MRI, magnetic resonance imaging",
        "Magnetic Resonance Imaging",
        "aducanumab"
    ],
    "methods": null,
    "publication_date": "2022-11-18",
    "pubmed_id": "36388611\n35289055\n22487856\n32165850\n23225010\n26871627\n29293211\n29377008\n30046111\n24670762\n29195051\n31564456\n31802237\n27582220\n20505438\n27239538\n29067304\n29221491\n29695589\n23578674\n21784348\n25669746\n31827267\n22305802\n19923550\n24450890\n34807243\n27334799\n27176461\n28269765\n21784350\n20548041\n30761062\n32772738\n34687956\n34585212\n31637009\n32082122\n31319495\n23478304",
    "results": null,
    "title": "Subcortical signal alteration of corticospinal tracts. A radiologic manifestation of ARIA: A case report.",
    "xml": "<Element 'PubmedArticle' at 0x7885026f6ed0>"
}