# Prominent urinary dysfunction and delayed antibody detection in patients with glial fibrillary acidic protein astrocytopathy: a case series analysis

## TL;DR

A study of six Chinese patients with GFAP astrocytopathy found common urinary issues and delayed antibody detection, highlighting the need for repeat testing.

## Contribution

The study highlights prominent urinary dysfunction and delayed GFAP antibody detection in Chinese GFAP-A patients, which is novel in this population.

## Key findings

- Four out of six patients exhibited prominent urinary dysfunction.
- Delayed detection of CSF GFAP antibody occurred in 83.3% of patients.
- Only 50% of patients showed brain or spinal cord MRI abnormalities.

## Abstract

Glial fibrillary acidic protein astrocytopathy (GFAP-A) is a rare central nervous system (CNS) autoimmune disorder with highly heterogeneous presentations. This study aims to describe the clinical and diagnostic features in a Chinese case series.

Six patients at a single tertiary center with positive GFAP antibody were included, the patients’ data were retrospectively analyzed.

The cohort included 3 males and 3 females, with a median age of 56 years (range 30–75). Prominent urinary dysfunction was observed in four patients (66.7%). Brain or spinal cord MRI abnormalities were present in only 50% (3/6) of patients. All patients exhibited CSF-specific oligoclonal bands and elevated indices of intrathecal IgG synthesis. A notable finding was the delayed detection of CSF GFAP antibody in five patients (83.3%), who tested negative at disease onset but turned positive upon follow-up testing weeks to months later.

This case series underscores the high frequency of autonomic urinary dysfunction and the potential for delayed antibody detection in Chinese GFAP-A patients. These findings suggest that clinical suspicion should remain high even with initial negative antibody testing, warranting repeat CSF analysis in suspected cases to avoid diagnostic delay.

The online version contains supplementary material available at 10.1186/s12883-025-04606-6.