Objectives-During an epidemiological study of Creutzfeldt-Jakob disease in Germany, Hashimoto's encephalitis was encountered as a diVerential diagnosis, which has not yet been described in this context. Methods-The symptoms and findings of seven patients who fulfilled the criteria for "possible"Creutzfeldt-Jakob disease are presented. Results-A Hashimoto's thyroiditis with antibodies against thyroglobulin or thyroid peroxidase, or both and a hypoechoic thyroid ultrasonogram were found in all cases. Analysis of CSF disclosed an increased leucocyte count in three patients, and a raised CSF:serum concentration ratio of albumin (QAlb) in four patients. The 14-3-3 protein, typical of Creutzfeldt-Jakob disease, could not be detected in any of our patients. No periodic sharp wave complexes, which are typical of Creutzfeldt-Jakob disease, were detected on EEG in any of the cases. By contrast with Creutzfeldt-Jakob disease, which leads to death within a few months, the patients with Hashimoto's encephalitis often recover quickly when treated adequately. All the patients improved after administration of corticosteroids. Conclusion-The clinical symptomatology of both diseases may be very similar: dementia, myoclonus, ataxia, and personality change or psychotic phenomena are characteristic symptoms. (J Neurol Neurosurg Psychiatry 1999;66:172-176) Keywords: Hashimoto's encephalitis; Hashimoto's thyroiditis; Creutzfeldt-Jakob disease; encephalopathyIn the course of our epidemiological study of Creutzfeldt-Jakob disease in Germany, we encountered Hashimoto's encephalitis as a differential diagnosis, which has not yet been described in this context. Hashimoto's encephalitis is associated with Hashimoto's thyroiditis.2 As yet, no data are available on the incidence of this disease; it is much more often found in women than in men. The most common symptoms are myoclonus, epileptic seizures, dementia, and disturbances of consciousness. In most cases therapy with corticosteroids leads to clear improvement or even disappearance of the symptoms.Chronic lymphocytic Hashimoto's thyroiditis is an often occurring (3%-4% of the population) organ specific autoimmune disease accompanied by development of goitre.29 Middle aged women are most often aVected. About one third of the patients are hypothyroid. In almost all cases antibodies against thyroglobulin, or thyroid peroxidase, or both are detectable. [30][31][32] Another typical feature is a hypoechoic thyroid ultrasonogram. Fine needle biopsy discloses inflammatory infiltrates with lymphocytes, plasma cells, colloid accumulation, and cell detritus.Creutzfeldt-Jakob disease is characterised by rapidly progressive dementia, myoclonus, pyramidal and extrapyramidal signs, and cerebellar symptoms.3 It is a rare disease (with an incidence of about one case/1000 000 population/ year), usually occurring in persons aged 60-70 years. Creutzfeldt-Jakob disease is also more often seen in women than in men. In most cases death occurs within a few months after onset. The clinical suspicion ...

The clinical presentation of the Heidenhain variant of CJD was shown to correlate with the neuropathological findings of gliosis and nerve cell loss. In patients with visual disorders of unclear origin and signs of dementia, the differential diagnosis of a Heidenhain variant of CJD must be taken into consideration.

Repetitive transcranial magnetic stimulation (rTMS) has been tried therapeutically in major depression. In order to investigate the therapeutic efficacy of rTMS in psychotic patients, 12 participants (four women, eight men) with schizophrenia according to DSM-IV criteria, aged 25 to 63 years (mean (+/-s.d) 40.4+/-11.0), were enrolled in the study. Following a double-blind crossover design, patients were treated at random with 2 weeks of daily left prefrontal rTMS (20 2s 20 Hz stimulations at 80% motor threshold over 20 min, dorsolateral preforntal cortex) and 2 weeks of sham stimulation. The Brief Psychiatric Rating Scale decreased under active rTMS (p <0.05), whereas depressive symptoms (BDI) and anxiety (STAI) did not change significantly. Prefrontal rTMS might be effective in the non-pharmacological treatment of psychotic patients.

The clinical presentation in patients with FFI may vary to a great extent. Genotyping of the patients was crucial in providing laboratory confirmation of the diagnosis of FFI, even when there was no family history of a prion disease.

Psychiatric patients represent a large part of the general interdisciplinary ED. Data may support quality assurance and service planning.

Background: Patients with psychiatric problems often seek help and assistance in hospital emergency departments. An important task of emergency room staff is to decide whether such patients need to be admitted or whether they can be treated on an outpatient basis.

Neurotoxicity of first-generation antipsychotics (FGAs) may be involved in lipid peroxidation, which is the pathogenesis of extrapyramidal symptoms, including tardive dyskinesia (TD). Blood samples at day 0, 7, and 21 drawn from patients taking antipsychotics were analyzed for malondialdehyde (MDA) in plasma, a marker of lipid peroxidation, by high-performance liquid chromatography. Of 115 patients enrolled, 92 patients completed the study. Most MDA levels were within normal ranges (<1.0 micromol/liter). Malondialdehyde levels in patients receiving clozapine (p = 0.002), quetiapine (p = 0.003), amisulpride (p = 0.008), and risperidone (p = 0.008) were significantly lower than within the first generation antipsychotic group. The authors conclude that lipid peroxidation is significantly higher in treatment with FGAs.

The combined application of clozapine and ziprasidone follows a neurobiologic rationale and appears to be safe and well tolerated without increasing the risk of side effects.