Opsoclonus as a Manifestation of Hashimoto's Encephalopathy (P01.115)

Abstract

Objective: To demonstrate early manifestation of opsoclonus as a rare clinical presentation of Hashimoto9s encephalopathy in a patient with subsequent steroid responsive symptoms and antibody titers. Background Hashimoto9s encephalopathy typically presents in two varieties: relapsing/remitting, which manifests with encephalopathy and stroke-like episodes; and a diffuse progressive type, which has an insidious onset with occasional fluctuations and manifests with psychiatric symptoms and dementia. Either type may also present with tremor, myoclonus, seizures, stupor, or coma. Encephalopathy usually develops over 1 to 7 days. Treatment with corticosteroids is almost always successful, although relapse may occur if this treatment is ceased abruptly. On extensive case review, there has only been one previous case of opsoclonus described as an early manifestation of Hashimoto9s encephalopathy. Design/Methods: Case Report. Results: We present a 59 year old male patient with subacute onset of opsoclonus and gait ataxia. He insidiously developed vertigo associated with gait ataxia and after a few days, vertical diplopia that evolved into involuntary saccadic eye movements. Extensive workup of infectious, autoimmune and paraneoplastic etiologies were undertaken and all studies were negative. Thyroglobulin antibodies and Thyroid peroxidase antibodies were found to be elevated (312 U/ml and 457 U/ml respectively; normal Conclusions: This case underscores the importance of investigating Hashimoto9s encephalopathy as an etiology of opsoclonus in the atypically presenting case. Disclosure: Dr. Salazar has nothing to disclose. Dr. Mehta has nothing to disclose. Dr. Zaher has nothing to disclose. Dr. Miller has nothing to disclose.