{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T05:24:34Z","timestamp":1768281874529,"version":"3.49.0"},"reference-count":13,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,18]],"date-time":"2021-09-18T00:00:00Z","timestamp":1631923200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Introduction: This paper describes a case of bi-frontal vasogenic oedema associated with bilateral frontal lobe and left parietal lobe white matter lesions where extensive investigations, including brain biopsy, failed to establish a diagnosis. Case Report: A 67-year-old female presented with three weeks\u2019 history of memory loss, fatigue, insomnia, nausea, and occasional dysphasia. Physical examination was unremarkable, yet cerebral CT and MRI showed bilateral frontal lobe vasogenic oedema. Extensive investigations, including: biochemical; radiological; immunological; microbiological; haematological; histopathological; and cytological, failed to establish a confirmed diagnosis. A multidisciplinary team could not achieve a consensus for this atypical presentation. Brain biopsy was unusual, showing destructive inflammatory and subtly granulomatous disease, but an exhaustive list of auxiliary tests could not confirm a cause, and consensus favoured glial fibrillary acidic protein (GFAP) autoimmune encephalopathy. Discussion: A definitive diagnosis could not be established for this patient despite a gamut of investigations. Although some of the presenting features were consistent with GFAP astrocytopathy, initial staining of the patient\u2019s CSF for neuronal antibodies was negative. Her symptoms and radiological changes of brain imaging improved without any corticosteroid therapy. Conclusions: Through this case report, the aim is to add to the repository of neurological sciences in the hope that future similar presentations could potentially lead to discovery of a new aetiology or contribute towards better understanding of an existing disease process.<\/jats:p>","DOI":"10.3390\/brainsci11091238","type":"journal-article","created":{"date-parts":[[2021,9,20]],"date-time":"2021-09-20T07:52:14Z","timestamp":1632124334000},"page":"1238","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Diagnostic Dilemma of White Matter Lesions and Cerebral Oedema without Identifiable Cause\u2014A Neurological Conundrum"],"prefix":"10.3390","volume":"11","author":[{"given":"Namraj","family":"Goire","sequence":"first","affiliation":[{"name":"Neurology Department, Liverpool Hospital, Liverpool, NSW 2170, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Buckland","sequence":"additional","affiliation":[{"name":"Department of Pathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia"},{"name":"Mind and Brain Institute, Sydney University, Camperdown, NSW 2050, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramesh","family":"Cuganesan","sequence":"additional","affiliation":[{"name":"Radiology Department, Liverpool Hospital, Liverpool, NSW 2170, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sameer","family":"Saleem","sequence":"additional","affiliation":[{"name":"Neurology Department, Liverpool Hospital, Liverpool, NSW 2170, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivienne","family":"Lea","sequence":"additional","affiliation":[{"name":"Histopathology Department, Liverpool Hospital, Liverpool, NSW 2170, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roy G","family":"Beran","sequence":"additional","affiliation":[{"name":"Neurology Department, Liverpool Hospital, Liverpool, NSW 2170, Australia"},{"name":"South Western Clinical School, University of NSW, Sydney, NSW 2170, Australia"},{"name":"School of Medicine, Griffith University, Southport, QLD 4215, Australia"},{"name":"Faculty of Sociology, Sechenov Moscow First State University, 119991 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1007\/s13311-019-00779-4","article-title":"The Medical Management of Cerebral Edema: Past, Present, and Future Therapies","volume":"16","author":"Halstead","year":"2019","journal-title":"Neurotherapeutics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.neuropharm.2018.08.004","article-title":"Pathophysiology and treatment of cerebral edema in traumatic brain injury","volume":"145","author":"Jha","year":"2019","journal-title":"Neuropharmacology"},{"key":"ref_3","unstructured":"Nehring, S.M., Tadi, P., and Tenny, S. 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Immunol., 9.","DOI":"10.3389\/fimmu.2018.02802"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1097\/WCO.0000000000000676","article-title":"Autoimmune glial fibrillary acidic protein astrocytopathy","volume":"32","author":"Kunchok","year":"2019","journal-title":"Curr. Opin. Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1111\/ene.13531","article-title":"Autoimmune glial fibrillary acidic protein astrocytopathy in Chinese patients: A retrospective study","volume":"25","author":"Long","year":"2018","journal-title":"Eur. J. Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Di, H., Yin, Y., Chen, R., Zhang, Y., Ni, J., and Zeng, X. (2021). Uncommon manifestations of a rare disease: A case of autoimmune GFAP astrocytopathy. 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BMC Neurol., 20.","DOI":"10.1186\/s12883-020-02021-7"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/9\/1238\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:02:11Z","timestamp":1760166131000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/9\/1238"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,18]]},"references-count":13,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["brainsci11091238"],"URL":"https:\/\/doi.org\/10.3390\/brainsci11091238","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,18]]}}}