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In 1966, Brain et al. described the first case of Hashimoto's encephalopathy in a patient with stroke-like episodes, seizure activities, and delirium. The symptoms were recurrent and reversible and were not associated with thyroid dysfunction 1 . Since then, Hashimoto's encephalopathy has been recognized as a rare condition associated to Hashimoto's thyroiditis and to the presence of high concentrations of antithyroid antibodies, unlike those described in myxedema and in thyrotoxicosis 2 . Two clinical forms have been described: the vasculitic form with stroke-like episodes, seizure activities, and slight cognitive decline; and the diffuse form with symptoms of depression, psychosis, myoclonus, tremors, delusion, fluctuations in the level of consciousness, and dementia. The clinical manifestations can be fluctuating or persistent, and reversible, if properly treated with immunosuppressive therapy 3 . In some cases, Hashimoto's encephalopathy can show rapidly progressive dementia, myoclonus, and electroencephalographic changes with periodic recurrence of the triphasic complexes similar to those of Creutzfeldt-Jakob disease, which makes a differential diagnosis essential to both pathologies 4 . We describe the case of a patient with Hashimoto's encephalopathy who showed clinical manifestations similar to those of Creutzfeldt-Jakob disease. The recognition of the condition was essential for the treatment and regression of the clinical presentation. CaSEA female patient, 68-years-old, Caucasian, widow, born in Rio de Janeiro, developed a clinical presentation of daily sadness, discouragement, decreased appetite, insomnia, and cognitive decline. The condition of the patient worsened with persecutory delusions, visual hallucinations, gait disturbance, tremor of the extremities, muscle spasms, and fluctuations in the level of consciousness. She had a history of hypothyroidism and did not use any medication. At admission, she was sleepy, disoriented, showing myoclonus, paratonia on the back of the head and arms, her deep reflexes were symmetrical with plantar flexion response and suction and grasping reflexes were present. The rest of the physical examination was normal.The laboratory exams, including a complete blood count; biochemistry; arterial gasometry; hepatic function tests; autoantibody tests, such as anti-nuclear factor (ANF), anti-Ro, antiLa, pANCA and cANCA, were either normal or negative. The lev-

We report a child who concurrently developed polycythaemia, dystonia, and T1 shortening in the globus pallidus, medial cerebral peduncle and superior cerebellar peduncles on MRI. With spontaneous resolution of the polycythaemia after about 2 1/2 years, the dystonia and MRI abnormalities also resolved. Although the physiological cause of the T1 shortening is not known, this appears to be another cause of T1 shortening in the basal ganglia.

Spinal subdural empyema is a very unusual condition. About 40 cases have been previously reported. The authors describe another case, mentioning the difficulties in diagnosis particularly when no primary infection is known. In these circumstances, the neurological signs and MRI are important; MRI demonstrates the level of the lesion and its subdural localization. Surgical treatment and antibiotics are clearly indicated and the earliest it is done, the better the results.

INTRODUÇÃO: A relação entre a miastenia e o timo é evidente e o tratamento atual desta condição inclui a timectomia. No entanto, uma revisão de nossa experiência com a timectomia revelou a necessidade do uso de uma técnica mais radical. OBJETIVO: Analisar retrospectivamente pacientes portadores de miastenia gravis que foram submetidos a timectomia radical por videotoracoscopia, ressaltando vantagens do método, complicações, análise histopatológica e resultados em relação ao controle da doença. MATERIAL E MÉTODO: Vinte e um pacientes miastênicos (18 do sexo feminino e três do sexo masculino, com idade variando de 17 a 51 anos) foram submetidos a timectomia por videotoracoscopia bilateral associada a cervicotomia transversa com ressecção da glândula tímica, dos tecidos peritímicos e das gorduras pericárdicas direita e esquerda. Todos os tecidos implicados foram analisados pela anatomia patológica separadamente. Houve acompanhamento por período médio de 39,2 meses. RESULTADOS: Não houve mortalidade operatória. Ocorreram duas (9,5%) lesões vasculares e um (4,8%) paciente passou a apresentar disfonia leve permanente. Dezenove (90,4%) pacientes estão com boa evolução, sem medicação ou com dose reduzida da mesma. A histopatologia demonstrou 10 hiperplasias do timo, seis involuções tímicas e cinco timos normais. A presença de tecido tímico ectópico foi detectada em seis (28,6%) pacientes. CONCLUSÃO: A timectomia radical por videotoracoscopia ofereceu bom controle da miastenia gravis. Fez-se ressecção de tecido tímico ectópico em alguns pacientes.