Autoimmune glial fibrillary acidic protein astrocytopathy mimicking acute ischemic stroke: a case report

Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is a recently identified autoimmune disorder of the central nervous system. It commonly manifests as meningitis, encephalitis, myelitis, or optic neuritis. However, presentations resembling stroke are exceedingly rare. Here, we report a case of autoimmune GFAP astrocytopathy initially misdiagnosed as acute ischemic stroke. The correct diagnosis was later established through the detection of GFAP antibodies in both the patient's serum and cerebrospinal fluid (CSF) using a cell-based assay (CBA). The patient initially responded to corticosteroid therapy; however, a relapse occurred during the tapering phase. After one year of treatment with oral prednisone and azathioprine, the patient achieved remission, with a subsequent negative result for GFAP antibodies. At the three-year follow-up, no recurrence was observed.