A case of Hashimoto's encephalopathy presenting with seizures and cognitive impairment

Abstract

Hashimoto's encephalopathy (HE) is a rare disease with unknown pathogenesis. An epileptic seizure is reported in association with HE. Here, the author reported an 18-year-old girl with a history of hyperthyroidism for one year. She was admitted to the hospital due to status epilepticus. Serum thyroid function test showed that the concentration of anti-thyroid peroxidase antibodies and thyroglobulin antibody were significantly elevated. Brain magnetic resonance imaging showed that multiple abnormalities varied from bilateral frontal, parietal, occipital-temporal lobe to cerebellum hemisphere. The patient's symptoms were significantly relieved after methylprednisolone therapy. At 3-month follow-up visits, she had been symptom free. HE is a diagnosis of exclusion and should be considered when evaluating a patient with cognitive dysfunction and high titers of anti-thyroid antibodies as it responds dramatically to steroids.

A case report on Hashimoto’s encephalopathy: an autoimmune neuroendocrine disorder

“…Diagnosis of HE should be considered in patients presenting with the neuropsychiatric symptoms and high levels of thyroid antibodies in serum or CSF, in particular thyroperoxidase antibodies excluding other causes of encephalopathy, such as the central nervous system involvement of vasculitic syndromes, metabolic disease, electrolyte imbalance, intracranial infection, poisoning or toxins, and neoplasm. 1,3,4,13,14 EEG abnormalities presented were nonspecific in majority of patients with slow background diffusion. 2,3,10,14 Brain MRI may show abnormalities such as cerebral atrophy, focal cortical abnormality, diffuse subcortical abnormality and nonspecific subcortical focal white matter abnormality.…”

“…1,3,4,13,14 EEG abnormalities presented were nonspecific in majority of patients with slow background diffusion. 2,3,10,14 Brain MRI may show abnormalities such as cerebral atrophy, focal cortical abnormality, diffuse subcortical abnormality and nonspecific subcortical focal white matter abnormality. 3,12,14 In our patient the diagnosis of HE was made by the noted high serum thyroid peroxidase antibodies, slow background diffusion of waves shown by EEG, positive neurological symptoms, normal MRI, after excluding all other potential causes.…”

“…2,3,10,14 Brain MRI may show abnormalities such as cerebral atrophy, focal cortical abnormality, diffuse subcortical abnormality and nonspecific subcortical focal white matter abnormality. 3,12,14 In our patient the diagnosis of HE was made by the noted high serum thyroid peroxidase antibodies, slow background diffusion of waves shown by EEG, positive neurological symptoms, normal MRI, after excluding all other potential causes. Steroid is the first line therapeutic choice, proved to be the most successful and effective treatment method for HE.…”

“…1,2 It is also termed as "steroid-responsive encephalopathy. 3 First described by the famous British neurologist L. Brain in 1966. 4 HE is more common to women than in men with a ratio of approximately 5:1 and occurs in all age groups.…”

Hashimoto's Encephalopathy Presenting with Seizure and Neurocognitive Symptoms: A Case Report

“…As in our patient symptoms improved significantly and rapidly after initiation of corticosteroid treatment. Clinical improvement with corticosteroid therapy is usually observed in the first 4-6 weeks and it has been considered to be part of the criteria for diagnosis of HE [2]. Other therapies such as plasmapheresis and immunosuppressant medications such as cyclophosphamide and methotrexate have been successfully used in patients nonresponsive to corticosteroids.…”