Hashimoto's encephalopathy presenting with neurocognitive symptoms: a case report

Abstract

IntroductionHashimoto's encephalopathy is a neurological disorder of unknown cause associated with thyroid autoimmunity. The disease occurs primarily in the fifth decade of life and may present in two types - a sudden vasculitic type or a progressive subacute type associated to cognitive dysfunction, confusion and memory loss.Case presentationWe report the case of a 62-year-old Hispanic woman, previously healthy, who developed a subacute onset of declining upper brain function. Serologic studies demonstrated high levels of antithyroid antibodies. Electroencephalographic and magnetic resonance image findings were consistent with Hashimoto's encephalopathy.ConclusionHashimoto's encephalopathy is a diagnosis of exclusion. This unusual disorder is often under-recognized because of the multiple and protracted neurocognitive manifestations; therefore, it is important to be aware of the clinical manifestations to make a correct diagnosis.

Cognitive Impairments in Hashimoto’s Encephalopathy: A Case-Control Study

“…This is consistent with the generally accepted viewpoint that treatment with steroids promotes marked clinical improvement and usually infers a good prognosis [27]–[30], [34], [35]. This is of considerable importance for patients with rare but treatable causes of encephalopathy presenting with acute or subacute cognitive decline.…”

“…The current diagnostic criteria confirm that Hashimoto's encephalopathy is a diagnosis of exclusion [30]. In the current study, patients were diagnosed with HE on the basis of typical clinical manifestations and a high titer of antithyroid antibodies (especially anti-TPO) in serum, and after the exclusion of other causes.…”

“…It is reported that the disease may present in two clinical types, a sudden vasculitic type presented stroke-like episodes or a progressive subacute type associated with cognitive dysfunction, confusion and memory loss [30]. Our study focused on cognitive impairments of the second type; the vasculitic type of HE was scarcely included.…”

Hashimoto’s Encephalopathy Presenting with Acute Cognitive Dysfunction and Convulsion

“…Clinical manifestations of HE are various and non-specific, but it is generally classified into two types. One consists of about 25% presenting focal neurological deficits repeatedly such as stroke and the other consists of about 75% showing diffuse progressive course such as dementia, confusion, and hallucination 1,2,5…”

“…Two clinical manifestations can occur simultaneously in the course of He 5. Here, it occurred in the way that convulsion is added while the sudden decline of cognitive function is the main symptom.…”