Joo Jae Young, Yoo Dallah, Ahn Tae-Beom
Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.
Department of Neurology, Kyung Hee University Hospital, Seoul, Korea.
J Mov Disord. 2022 Jan;15(1):66-70. doi: 10.14802/jmd.21115. Epub 2021 Nov 25.
Movement disorders associated with glial fibrillary acidic protein (GFAP) autoantibodies have rarely been reported as ataxia or tremors. A 32-year-old man with headache and fever, initially diagnosed with viral meningoencephalitis, showed gradual improvement with empirical treatment. Two weeks after the illness, he suddenly developed orofacial, tongue, and neck dyskinesia accompanied by oculomotor abnormalities, which developed into severe generalized choreoballism. Brain magnetic resonance imaging (fluid-attenuated inversion recovery) showed signal hyperintensities in the bilateral globus pallidus interna. The clinical picture suggested an acute inflammatory trigger of secondary autoimmune encephalitis. The autoimmune antibody test was positive for GFAP, with the strongest reactivity in the cerebrospinal fluid (CSF) before treatment and decreased reactivity in serial CSF examinations during immunotherapy. Dyskinesia gradually improved to the extent that it could be controlled with only oral medications. This patient presented with parainfectious GFAP meningoencephalitis with distinctive clinical features and imaging findings.
与胶质纤维酸性蛋白（GFAP）自身抗体相关的运动障碍很少被报道为共济失调或震颤。一名32岁男性，伴有头痛和发热，最初被诊断为病毒性脑膜脑炎，经经验性治疗后逐渐好转。患病两周后，他突然出现口面部、舌头和颈部运动障碍，并伴有眼球运动异常，进而发展为严重的全身性舞蹈样手足徐动症。脑部磁共振成像（液体衰减反转恢复序列）显示双侧内侧苍白球信号增强。临床表现提示继发性自身免疫性脑炎的急性炎症触发因素。自身免疫抗体检测显示GFAP呈阳性，治疗前脑脊液（CSF）中的反应性最强，免疫治疗期间连续的脑脊液检查中反应性降低。运动障碍逐渐改善，最终仅通过口服药物即可控制。该患者表现为具有独特临床特征和影像学表现的感染后GFAP脑膜脑炎。
