ArticleNeurology(R) neuroimmunology & neuroinflammation2026
Fulminant Amyloid β-Related Angiitis With Herniation and Rapid Response to Tocilizumab: A Case Report.
Article in Neurology(R) neuroimmunology & neuroinflammation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Steroid-responsive inflammatory leptomeningeal encephalitis temporally associated with lecanemab therapy: A case report.Journal of Alzheimer's disease reportsArticle
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7 authors.
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Abstract
objectivesAmyloid β-related angiitis (ABRA) is a rare, inflammatory vasculopathy resulting from intravascular amyloid deposition. We describe a refractory presentation of ABRA and its response to tocilizumab.
methodsSingle-patient, biopsy-confirmed ABRA with serial MRI and clinical outcomes. Treatments included high-dose IV methylprednisolone, hyperosmolar therapy, cyclophosphamide, and escalation to tocilizumab.
resultsA 70-year-old woman presented with seizure and focal deficits. Initial MRI showed multifocal subcortical T2/FLAIR hyperintensities with cortical microhemorrhages without enhancement. Despite steroids, interval imaging showed progressive vasogenic edema, new leptomeningeal enhancement, and rising microhemorrhage burden. She developed severe headache and worsening hemiparesis; CT/MRI demonstrated marked edema with subfalcine/uncal herniation. Biopsy confirmed ABRA. Edema did not improve with steroids, maximal hyperosmolar therapy, or cyclophosphamide. After tocilizumab, MRI within 48 hours showed reduced edema and midline shift with near-resolution of sulcal enhancement; hemiparesis markedly improved without hemicraniectomy. DISCUSSION: We expand the phenotypic spectrum of ABRA by presenting a herniation syndrome associated with fulminant disease and a clear clinicoradiographic natural history. The precipitous progression of microhemorrhage accrual suggests a pathophysiologically distinct mechanism of disease from cerebral amyloid angiopathy-related inflammation. IL-6 receptor blockade was associated with rapid clinical and radiographic improvement and stabilization, supporting prospective evaluation of tocilizumab in amyloid-related neuroinflammatory disorders.
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