Amyloid-Related Imaging Abnormalities (ARIA) in Alzheimer’s Disease

A patient in his early 50s with mild cognitive impairment due to sporadic Alzheimer’s disease (no genetic cause had been confirmed) reported a 6-month history of tension-type headaches. The patient had not received anti-amyloid antibody treatment. Neurological examination was unremarkable. Brain magnetic resonance imaging (MRI) revealed amyloid-related imaging abnormalities with edema/effusion (ARIA-E, Figure) and hemosiderin deposits (ARIA-H) in the form of multiple microhemorrhages in the left frontal region, a brain area with multiple amyloid deposits on previous positron emission tomography. The term ARIA—which occur spontaneously, as in the current case, or during amyloid-modifying treatments—was first introduced in the context of clinical studies and has gained increasing relevance in connection with anti-amyloid antibodies. Following high-dose intravenous glucocorticoid therapy with subsequent oral tapering, the headaches resolved rapidly and completely. MRI follow-up at 10 weeks demonstrated full resolution of the edema (Figure). ARIA also occur in the spontaneous course of Alzheimer’s disease, and symptomatic ARIA-E can show an excellent response to glucocorticoids.

Figure

Figure: MRI FLAIR images. ARIA, amyloid-related imaging abnormalites; FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging. We thank Conradia Radiologie München for providing the MRI images.

PD Dr. med. Jonathan Vöglein, MHBA; Prof. Dr. med. Johannes Levin; Neurologische Klinik und Poliklinik, LMU Klinikum, München,
Deutsches Zentrum für neurodegenerative Erkrankungen, München, [e-mail]

Prof. Dr. Dr. Matthias Brendel, MHBA; Klinik und Poliklinik für Nuklearmedizin, LMU Klinikum, München,
Deutsches Zentrum für neurodegenerative Erkrankungen, München

Conflict of interest statement: JV has received consultancy fees, speaker honoraria, and/or travel support from Biogen, Eisai, Lilly, and Novo Nordisk.
JL has received consultancy fees and/or speaker honoraria from Axon Neuroscience, Bayer Vital, Biogen, Eisai, TEVA, Zambon, Esteve, Lilly, BIAL, Merck, and Roche. MB declares that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Vöglein J, Brendel M, Levin J: Amyloid-related imaging abnormalities (ARIA) in Alzheimer’s disease.
Dtsch Arztebl Int 2026; 123: 366. DOI: 10.3238/arztebl.m2025.0204