Glial fibrillary acidic protein autoimmunity in reversible splenial lesion syndrome: diagnostic and therapeutic implications

TL;DR

This paper explores how to differentiate a rare autoimmune condition from viral encephalitis when both involve a specific brain lesion.

Contribution

The paper presents a diagnostic approach to distinguish GFAP-A from viral encephalitis in the context of RESLES.

Findings

GFAP-A can mimic viral encephalitis in patients with RESLES, complicating diagnosis.

MRI findings and clinical evaluation help differentiate GFAP-A from viral encephalitis.

Corpus callosum splenium lesions are rare in GFAP-A but significant when present.

Abstract

Autoimmune GFAP astrocytopathy (GFAP-A) is a neuroinflammatory condition that often involves the brain, meninges, and spinal cord. Its characteristic MRI finding consists of linear or radial perivascular enhancement adjacent to the ventricles. While corpus callosum splenium lesions occur in only 5% of cases, association with reversible splenial lesion syndrome (RESLES) is very rare. In such instances, GFAP-A can clinically resemble viral encephalitis, making diagnosis difficult. This article discusses how to distinguish GFAP-A from viral encephalitis using clinical and auxiliary examinations when RESLES is present.

Figures