Abstract
Patients with Hashimoto encephalitis may present with seizures, stroke-like episodes, transient focal and global neurological deficits, and a variety of neuropsychiatric disturbances. The encephalopathy evolves with elevated anti-thyroid peroxidase antibodies, independent of hormonal thyroid function. A teenager experienced repeated concussions antedating onset of Hashimoto encephalopathy. Neuroradiological studies showed overlapping areas of altered brain metabolism and vascular perfusion in the hippocampus, deemed most vulnerable in autoimmune encephalopathy. Concussive brain injury may be a contributing factor in the development of encephalopathy due to its capacity to alter the blood-brain barrier.
Highlights
Hashimoto thyroiditis and encephalopathy are extensively reviewed by Younger [1]
The diagnosis of Hashimoto encephalopathy rests upon the presence of thyroiditis, with measurably high titers of thyroid peroxidase (TPO) or thyroglobulin (Tg) antibodies, clinical encephalopathy, and absent evidence of cerebrospinal fluid (CSF) bacterial or viral infection [4]
Kishitani and coworkers [8] reported anti-NH2-terminal of α-enolase antibodies in 24% of Hashimoto encephalopathy patients’ sera, and identified unilateral and bilateral mesial temporal lobe signal abnormalities on brain magnetic resonance imaging (MRI) that were associated with epileptic foci, suggesting a relation to limbic encephalitis
Summary
Hashimoto thyroiditis and encephalopathy are extensively reviewed by Younger [1]. Neurologists have been pursuing the associated but rare encephalopathy associated with Hashimoto thyroiditis for over fifty years. The diagnosis of Hashimoto encephalopathy rests upon the presence of thyroiditis, with measurably high titers of thyroid peroxidase (TPO) or thyroglobulin (Tg) antibodies, clinical encephalopathy (as evidenced by clouding of consciousness with reduced wakefulness, attention, or cognitive function), and absent evidence of cerebrospinal fluid (CSF) bacterial or viral infection [4]. As it is unknown whether anti-thyroid antibodies and thyroid dysfunction contribute to the pathogenesis of encephalopathy
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