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Glial fibrillary acidic protein IgG related myelitis: characterisation and comparison with aquaporin-4-IgG myelitis
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  • Published on:
    Area postrema syndrome: another feature of anti-GFAP encephalomyelitis
    • Jonathan Ciron, Neurologist University Hospital of Toulouse, France
    • Other Contributors:
      • Damien Biotti, Neurologist
      • Thierry Tchoumi, Neurologist
      • Marie Benaiteau, Neurologist
      • Nicolas Maubeuge, Neurologist
      • Romain Marignier, Neurologist

    Dear Editor,

    We read with great interest the recent paper of Sechi et al. that describes 13 patients with anti-GFAP related myelitis and compares them with 41 patients with anti-AQP4 related myelitis.1 To date, very little data is available about anti-GFAP related disorders.2-3 Sechi et al. highlight some differences between the two entities to help clinicians differentiate them.1 One of these clinical differences relates to area postrema syndrome (APS). Indeed, it is well known that APS is a classical feature of neuromyelitis optica spectrum disorders, particularly among anti-AQP4 positive patients.4 Sechi et al. report this syndrome as a prodromal event in 20% of anti-AQP4 related myelitis. Conversely, the authors do not report any case of APS preceding or accompanying myelitis related to anti-GFAP.1 Given these data, APS could be an indicator for ruling out anti-GFAP encephalomyelitis, particularly useful for centers that do not yet have access to biological testing for anti-GFAP Abs.
    However, we report the case of a 41-year-old woman who in April 2016 developed intractable nausea and vomiting lasting for five weeks and leading to 35 kilograms in weight loss. An extensive search for a digestive disease was negative, and no neurological explorations were performed. One month following the resolution of digestive symptoms, she developed mental confusion, diplopia, dysarthria, dizziness, bilateral blurred vision (with optic disc edema) and paraparesis. Brain...

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    Conflict of Interest:
    None declared.