Page 126 - Read Online

Case Report

A case of Hashimoto's encephalopathy presenting

with seizures and cognitive impairment

Xing-Yong Chen, Yin-Zhou Wang, Hui-Xin Lei, Xu Zhang

Department of Neurology, Fujian Provincial Hospital, Fujian Medical University Shengli Clinical College, Fuzhou 35000, Fujian, China.
A B S T R AC T
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.
Key words: Hashimoto’s encephalopathy; anti-thyroid antibodies; steroid responsive encephalopathy

INTRODUCTION 22, which was lower than normal] as well as bilateral
limbs dystaxia. The white blood cell count was 7.55 ×
Hashimoto’s encephalopathy (HE), also termed as 10 /L, hemoglobin 156 g/L, and C-reactive protein 0.09
9
“steroid-responsive encephalopathy associated with mg/dL. Routine biochemical analyses of liver, renal, and
autoimmune thyroiditis”, is a rare immune-mediated blood glucose were all within normal limits. The serum
encephalopathic event which affects children and sodium was 131 mmol/L, potassium 3.3 mmol/L, and
adolescents. It is characterized by altered mental chlorine 91 mmol/L. The cerebrospinal fluid (CSF)
status, seizures, and cognitive dysfunction. It was analysis displayed normal pressure (145 mmH O) and
2
reported seizures happened in 66% of HE, among a normal cell count and protein and glucose levels.
which status epilepticus in 12%. We reported a The serum and CSF of TORCH [toxoplasmosis, other
[1]
young female patient with generalized, tonic-clonic (viruses), rubella cytomegalovirus, herpes (simplex
seizures and cognitive impairment changes who viruses)] as well as the serum rapid plasma regain test,
responded well to steroid treatment. anti-human immunodeficiency virus antibody, epatitis
B surface antigen and antineutrophil cytoplasmic
CASE REPORT antibody were negative. The plasma concentrations
of sex hormone and cortisol were normal. Serum
An 18-year-old girl who suffered from status thyroid function test showed that triiodothyronine
epilepticus was admitted to the hospital. She had a (T3) < 0.300 nmol/L(reference intervals 1.30-3.10
history of hyperthyroidism for one year, and was nmol/L), free triiodothyronine (FT3) < 0.400 pmol/L
treated with propylthiouracil (50 mg/day). There was (reference intervals 3.10-6.80 pmol/L), upersensitive
no family history of psychiatric diseases, seizures, or thyroidstimulating hormone (S-TSH) 0.01 mIU/L
other problems. Her initial vital signs were stable. On (reference intervals 0.27-4.20 mIU/L), anti-thyroid
physical examination, she was conscious, cooperative, peroxidase antibodies (TPOAb) > 600.0 IU/mL
and oriented to person and time. However, she had (reference intervals 0.00-34.00 IU/L), thyroglobulin
short-term memory and computing power loss [the antibody (TGAb) 2,189.00 IU/mL (reference intervals
mini-mental state examination (MMSE) score was 10.00-115.00 IU/mL). Electroencephalography showed a
marked slowing of background rhythm as an indicator
Corresponding Author: Dr. Xu Zhang, Department of of encephalopathy but no activity corresponded with
Neurology, Fujian Provincial Hospital, Fujian Medical University
Shengli Clinical College, Fuzhou 350001, Fujian, China.
E-mail: zhangxufjsl@163.com This is an open access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non-commercially, as long as the
Access this article online author is credited and the new creations are licensed under the identical terms.
Quick Response Code:
Website: For reprints contact: service@oaepublish.com
www.nnjournal.net
How to cite this article: Chen XY, Wang YZ, Lei HX, Zhang X. A case
of Hashimoto's encephalopathy presenting with seizures and cognitive
DOI: 10.20517/2347-8659.2015.57 impairment. Neuroimmunol Neuroinflammation 2016;3:117-9.
Received: 18-12-2015; Accepted: 25-02-2016

© 2016 Neuroimmunology and Neuroinflammation | Published by Published by OAE Publishing Inc. 117