How do you taper steroids for CAA-ri?

Thank you for the question. I have treated two patients so far for CAA-ri, one biopsy-confirmed. I also reviewed the literature on the entity. An oral steroid taper over several months is recommended to reduce the chances of recurrence. There’s no established standard timeline I have found. Monitoring is with both serial cognitive and symptom assessments as well as MRI. The FLAIR is the most important sequence to monitor as one assesses for resolution of the asymmetric vasogenic edema that characterizes CAA-ri. Barring side effects from steroids, I begin the gradual taper when the patient returns to their cognitive baseline and the vasogenic edema resolves. I’ll be happy to hear from those who have more experience with CAA-ri.