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A case of presumed Hashimoto's encephalopathy (HE) is presented. The presentation included memory loss, delusions, functional decline and culminated in a generalized seizure. Anti-thyroid antibodies were detected and symptoms resolved with prednisolone. Patients with HE may present with prominent neuropsychiatric symptoms, attract psychiatric diagnoses and present to psychiatric services. Primarily a diagnosis of exclusion, HE should be considered in cases of encephalopathy in which standard investigations are negative.

An unusual syndrome is described consisting of right hemiplegia, right hemisensory loss, mild naming disturbance, and severe alexia coupled with normal expressive language and ability to write. The clinical syndrome of alexia without agraphia strongly suggests involvement of the left posterior cerebral artery. A study of the territory of distribution of the posterior cerebral artery would appear to confirm the possibility that occlusion of this vessel could produce the entire symptom picture. Of particular interest was the unusual hemiplegia, involving both limbs and face equally, but with a minimum of spasticity.

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