PMC10249068_01
Brain MRI revealed hyperintense of the corpus callosum on T2 sequence MRI (A) and diffusion-weighted MRI (B) before immunotherapy. MRI postcontrast axial T1-weighted scans (C) and sagittal T1-weighted scans (D) showed leptomeningeal enhancement of the pons and medulla before immunotherapy. Sagittal T2 sequence MRI showed no hyperintensities throughout the cervical spinal cord and thoracic spinal cord (E). The high signal intensity of the corpus callosum on diffusion-weighted MRI disappeared after immunotherapy (F). MRI postcontrast axial T1-weighted scans and sagittal T1-weighted scans showed that leptomeningeal enhancement of the pons and medulla completely disappeared after immunotherapy (G, H). Arrows indicate leptomeningeal enhancement. Oval shape indicates the lesion in the corpus callosum.
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F1
Brain magnetic resonance imaging (MRI) revealed abnormal leptomeningeal enhancement in the brainstem (Figures 1C, D). In addition, brain MRI showed the high signal intensity of the corpus callosum on T2 sequence MRI (Figure 1A) and diffusion-weighted MRI (Figure 1B). After completing glucocorticoid pulse therapy, all symptoms of the patient disappeared except urinary retention, and a repeat brain MRI revealed the lesion in the corpus callosum and abnormal leptomeningeal enhancement in the brainstem disappeared (Figures 1F-H). In addition, the spine MRI showed no T2 hyperintensities throughout the cervical spinal cord and thoracic spinal cord (Figure 1E).
Cell-based indirect immunofluorescence assays demonstrating positive GFAPalpha-immunoglobulin G in CSF (A) and serum (B) from our patient. (C, D) represent negative controls.
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F2
We sent an autoimmune encephalitis panel and demyelinating antibody panel including serum and CSF samples, and the anti-GFAP antibody was positive (1:10) in the serum and CSF analysis (Figure 2).