Hashimoto Encephalopathy (Autoimmune Encephalitis)

Abstract

Patients with Hashimoto thyroiditis may have neurologic manifestations that have been described in the literature for some decades now; these include psychiatric disorders, abnormal movements, and simulation of cerebrovascular events. Nuclear magnetic resonance (MRI) studies have revealed diffuse leukoencephalopathy in most cases. We describe a case having clinical manifestations simulating cerebrovascular events, together with cognitive alterations (a presentation already described in other patients). Among the 2 main forms of neurologic manifestations, the cognitive type, which is probably associated with endocrinologic alteration, may improve with hormone supplement. Those alterations simulating cerebrovascular events are most probably related to autoimmune vasculitis. The latter may improve with the administration of corticosteroids, which are proposed as treatment of this disorder.

Time course of Hashimoto's encephalopathy revealed by MRI: Report of two cases

“…Although the two cases started with similar ischemiclike appearance caused by cytotoxic edema, they had different MRI outcomes: reversible process and necrotic process. In addition to our findings, diffuse demyelination, atrophy and other outcomes were also reported [6,9,11] These MRI appearances implied distinct pathological courses of HE. At present, two main hypotheses including immunological mediated small vessel vasculitis and direct harm of anti-neuronal autoantibodies have been suspected of causing HE [4,24].…”

“…However, until now, MRI reports on HE were limited. Approximately 50% of MRI findings were normal, and the remaining manifested nonspecific features, including ischemic-like changes, demyelination, vasogenic edema and atrophy [6][7][8][9][10][11]. The diverse MRI findings of HE lead to difficulty in understanding and monitoring the genesis, development and prognosis of this disease.…”

Encephalopathy Associated with Autoimmune Thyroid Disease: A Potentially Reversible Condition

“…Since the first description of Hashimoto's encephalopathy in 1966 [ 21 ], the clinical spectrum has been widened and different possible presentations are now recognized, including acute-onset presentations as stroke-like episodes, epilepsy, or psychosis, and a slowly progressive presentation, which appears to be more common, characterized by cognitive and behavioral disturbances which may be associate with tremor, myoclonus, or ataxia [ 1 – 4 ].…”

Successful response to intravenous immunoglobulin as rescue therapy in a patient with Hashimoto's encephalopathy

“…There are two major presentations: progressive encephalopathy and symptoms resembling stroke,12 with almost a third of patients having stroke-like symptoms. Encephalopathy is usually accompanied by cognitive and behavioural alterations.…”