Autoimmune glial fibrillary acidic protein astrocytopathy: clinical analysis and review of 15 cases.

BACKGROUND: To review clinical characteristics, auxiliary examination results, treatment effects, and outcomes of patients with autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A). METHODS: We collated and retrospectively analyzed clinical data of 15 patients admitted with clinical characteristics of an autoimmune GFAP-A acute encephalitis or meningitis phenotype. RESULTS: All patients were diagnosed with acute-onset meningoencephalitis and meningoencephalomyelitis. Initial presentations included pyrexia and headache at onset; dual symptoms of prominent tremor with urinary and bowel dysfunction; ataxia, psychiatric and behavioral abnormalities, and impaired consciousness; neck resistance; reduced extremity muscle strength; blurred vision; epileptic seizures; and reduced basic blood pressure. Cerebrospinal fluid (CSF) examination showed that the degree of protein elevation was significantly higher than the degree of increase in white blood cells. Moreover, in the absence of obvious low chloride and glucose levels, CSF chloride levels decreased in 13 patients, accompanied by a CSF glucose level decrease in four. Brain abnormalities were found in magnetic resonance imaging of ten patients, with a linear radial perivascular enhancement present in the lateral ventricles of two patients and symmetric abnormalities in the splenium of the corpus callosum in three patients. CONCLUSIONS: Autoimmune GFAP-A may be a spectrum disorder, with acute- or subacute-onset meningitis, encephalitis, and myelitis being the main phenotypes. When used for acute stage treatment, combined hormone and immunoglobulin therapy was superior to hormone pulse therapy or immunoglobulin pulse therapy alone. However, hormone pulse therapy alone without immunoglobulin pulse therapy was associated with a greater number of remaining neurological deficits.

Deep-learning-based MRI in the diagnosis of cerebral infarction and its correlation with the neutrophil to lymphocyte ratio.

BACKGROUND: Dizziness is a common symptom in clinic, but there lacks an effective treatment method. This study sought to examine the efficiency of deep learning (DL)-based magnetic resonance imaging (MRI) in the diagnosis of cerebral infarction mainly manifesting as vertigo using the neutrophil to lymphocyte ratio (NLR) and other routine blood indexes. METHODS: An improved multiscale U-Net [MS (U-Net)] model, based on the U-net model, was proposed and applied in the segmentation of MRI of the brain. One hundred and fifteen vertiginous cerebral infarction (VCI) patients, admitted to the Department of Neurology at Huizhou Central People's Hospital from January 2016 to December 2020, were chosen as the research subjects. Based on the MRI segmentation results for the brain, the patients were allocated to the benign paroxysmal positional vertigo (BPPV) group or acute cerebral infarction (ACI) group. Additionally, 50 healthy individuals, whose venous blood was collected for routine blood analyses, were allocated to the control group. RESULTS: The MS (U-Net) model accomplishes MRI segmentation of the brain, and its segmentation results were much closer to the real results than those of the U-Net model. Compared to the control group, the monocyte count (MC), low-density lipoprotein/high-density lipoprotein (LDL/HDL) ratio, and NLR of patients in the BPPV and ACI groups showed an obvious increase (P<0.05), as did the white blood cell count, triglyceride (TG) level, and other indexes of ACI patients (P<0.05). In relation to the diagnosis, the areas under the curve for the TG level, LDL/HDL ratio, and NLR of the BPPV and ACI groups were 0.930 and 0.760, 0.900, and 0.770, 0.945 and 0.855, respectively (P<0.05). CONCLUSIONS: DL can accomplish MRI segmentation in cerebral infarction patients, and the TG level, LDL/HDL ratio and NLR can be used in the diagnosis of VCI.

Cerebrospinal fluid pentraxin 3 and CD40 ligand in anti-N-menthyl-d-aspartate receptor encephalitis.

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder of the central nervous system whose pathogenesis involves interleukin (IL)-6 and IL-17A. We examined the correlations between CSF concentrations of the acute-phase protein pentraxin 3 (PTX3), the chronic inflammatory mediator CD40L, IL-6, and IL-17A in anti-NMDAR encephalitis, and the impact on clinical outcome. PTX3, CD40L, IL-6, and IL-17A were significantly higher in the CSF of patients with anti-NMDAR encephalitis than in controls. Within the former, PTX3 levels correlated positively with IL-6 and the mRS, and CD40L levels with IL-17A and the mRS. Higher PTX3 and CD40L levels may reflect the underlying neuroinflammation.