Extensive Corticospinal Tract Involvement in a Patient With Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy

A 54-year-old man developed fever, headache, and disorientation, followed by generalized seizures and respiratory arrest, requiring mechanical ventilation.CSF analysis showed 384 cells/L (99% monocytes), a protein level of 210 mg/dL, and a glucose level of 50 mg/dL.Infectious Figure 1 Corticospinal Tract Lesions on Diffusion-Weighted MRI of the Brain and Spine (A.a, C.a, D.a) Diffusion-weighted imaging (DWI) revealed radial periventricular hyperintensity extending to the posterior limb of the internal capsule, the ventral brainstem, and the lateral spinal cord; (A.b, C.b, D.b) apparent diffusion coefficient (ADC) maps of the images.(B.a)The corpus callosum also exhibited hyperintensity, (B.b) ADC maps of the images.Areas of high signal intensity on DWI in the brain demonstrated markedly restricted diffusion on ADC maps.(E) Sagittal T2-weighted imaging demonstrated an extensive longitudinal spinal cord lesion.