Leptomeningeal Gadolinium Enhancement in Autoimmune GFAP Astrocytopathy

A 46-year-old woman presented with urinary retention, headache, tremor, ataxia, mental slowness, and tetra-hyperreflexia following urinary infection. MRI showed signs of encephalomyelitis with diffuse postcontrast 3D fluid-attenuated inversion recovery leptomeningeal enhancement, a common finding in several neuroinflammatory conditions1 (Figures 1 and 2). An extensive diagnostic workup (serum and CSF neurotropic viruses, Borrelia burgdorferi, Treponema pallidum, serum anti–myelin oligodendrocyte glycoprotein and anti–aquaporin-4 antibodies, antinuclear antibodies, extractable nuclear antigen, antineutrophil cytoplasmic antibodies, angiotensin-converting enzyme and α-chitotriosidase levels, quantiferon, total body CT scan) was unrevealing. CSF analysis disclosed lymphocytic pleocytosis (204 leukocytes/μL), high protein levels (123 mg/dL), CSF-restricted oligoclonal bands, and anti–glial fibrillary acidic protein (GFAP) antibodies (cell-based assay), leading to the diagnosis of autoimmune GFAP astrocytopathy.2 After receiving IV methylprednisolone, the patient improved substantially.

Read article at journal's website

Related Articles

Responses

Your email address will not be published.