Neuronal astrocytes rely on a cytoskeletal element known as glial fibrillary acidic protein (GFAP), which facilitates their main structural framework, maintaining neurological function, repair, and lastly the blood-brain barrier. Pathologies such as neoplasms, autoimmune-mediated inflammation, and even genetic dysfunction can directly harm this element and result in malfunctioning astrocytes, CNS inflammation, and cell death. In this case report, we will create a timeline from presentation to remission of a rare entity known as autoimmune GFAP astrocytopathy for a middle-aged male with a wide variety of exposures and concomitant conditions. This case is unique, as in many cases, only one antibody marker was found on CSF analysis. After careful review of imaging from our institutional PACS, select slices were anonymized and organized here for review. The study aims to highlight the timeline of imaging features and their evolution. Advanced imaging techniques were also present and contributed to previous supporting evidence. Prior studies describe this entity with a wide variety of imaging features. Its most unique feature may be radial perivascular enhancement. What was not previously known is when these findings may present and how their absence within the time period of imaging may impact the investigation.
Rahman et al. (2026) studied this question.