Bilateral Orbital Fat Hyperintensity in Early Glial Fibrillary Acidic Protein Astrocytopathy: A Case Report.
Yusuke Ito, Ken Ohyama, Akio Kimura et al.
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Case in brief
A 26-year-old woman presented with headache, fever, and bilateral ocular pain. MRI revealed hyperintensity in the bilateral orbital fat without optic nerve involvement, while initial intracranial MRI was unremarkable. CSF analysis showed increased lymphocytes and anti-GFAP antibodies. Following high-dose corticosteroid therapy, there was rapid clinical improvement and resolution of both orbital and intracranial MRI lesions.
What made this case unusual
The case highlights bilateral orbital fat hyperintensity as an early manifestation of GFAP astrocytopathy, which is not commonly recognized in the initial presentation.
Diagnostic / clinical pearl
Clinicians should consider orbital fat hyperintensity on MRI as a potential early indicator of GFAP astrocytopathy, especially in patients with unexplained ocular symptoms.
Why it matters
Identifying this atypical MRI finding can lead to earlier diagnosis and treatment, potentially improving patient outcomes in GFAP astrocytopathy.