Hashimoto’s Encephalopathy Presenting with Progressive Cerebellar Ataxia

Algahtani, Hussein; Fatani, Anmar N.; Shirah, Bader; Algahtani, Raghad

doi:10.17712/nsj.2019.4.20190016

Cited by 5 publications

(15 citation statements)

References 13 publications

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“…At the time of presentation, most patients have normal thyroid function. Females are 10 times more affected than males, and it's relapsing in nature which could be a diagnostic sign [4].…”

Section: Discussionmentioning

confidence: 99%

“…Hashimoto's encephalopathy (HE) is associated with Hashimoto's thyroiditis and is a relapsing-remitting neurological disease with a varied presentation ranging from seizures, cognitive impairment, and stroke-like symptoms [2][3]. Cerebellar ataxia is rare as a presentation of HE [4]. Women are more affected than males, with the average age being 40 years [3].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cerebellar Ataxia in the Setting of Hashimoto’s Thyroiditis: A Case Report

Sardana¹,

Johnson²,

Cheng³

et al. 2022

Cureus

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Hashimoto's encephalopathy (HE) is a rare diagnosis with a heterogenous presentation. It may not be directly related to thyroid dysfunction as most patients are euthyroid when the symptoms start. There has been a lack of consensus building on the pathophysiology of HE, but most of the evidence points towards autoimmune vasculitis as the underlying process. HE can present as seizures, cognitive dysfunction, tremors, or stroke-like symptoms with focal neurological deficits. Cerebellar ataxia (motor incoordination due to dysfunction of the cerebellum) is seen in HE but is a rare occurrence.The objective of the article was to present a case of cerebellar ataxia in a patient with Hashimoto's thyroiditis. A 30-year-old previously healthy female presented with quickly progressive cerebellar ataxia, bilateral (B/L) limb weakness, and excessive tearing. She was found to have high titers of anti-TPO (antithyroid peroxidase) antibodies; a biopsy confirmed Hashimoto's thyroiditis and a battery of negative tests excluding other causes of encephalopathy. Hence, confirming a diagnosis of HE. The patient was given glucocorticoids which relieved her symptoms. After being symptom-free for a few months, she relapsed and was unsuccessfully treated by the steroids. Upon this, she was given IV immunoglobulins, which helped achieve complete resolution. HE can be treated with immunotherapy, and most patients have a good prognosis, but some can have persistent neurological defects if left untreated or treatment is delayed. Relapses are common and may require a more extended treatment regimen.

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“…At the time of presentation, most patients have normal thyroid function. Females are 10 times more affected than males, and it's relapsing in nature which could be a diagnostic sign [4].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cerebellar Ataxia in the Setting of Hashimoto’s Thyroiditis: A Case Report

Sardana¹,

Johnson²,

Cheng³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…In the majority of cases (7,8,(11)(12)(13)(14)(15)(16)(17), the initial treatment consisted in oral or intravenous corticotherapy, among with other immunosuppressive medication (e.g., methotrexate) or symptomatic medication (e.g., antiepileptic drugs). No improvement, partial improvement or full improvement but with the relapse of HE were identified.…”

Section: Intravenous Immunoglobulinmentioning

confidence: 99%

The use of intravenous immunoglobulin in the treatment of Hashimoto’s encephalopathy: case based review

Şorodoc,

Constantin,

Asaftei

et al. 2023

Front. Neurol.

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BackgroundHashimoto’s encephalopathy (HE) is a controversial immunological neuropsychiatric disease, with a poorly understood pathogenesis. It is characterized by symptoms of acute or subacute encephalopathy which usually occur in the presence of elevated levels of antithyroid antibodies. Even though it is also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), some cases appear to be steroid-resistant. This review examined whether treatment of Hashimoto’s encephalopathy with intravenous immunoglobulin (IVIG) is associated with better clinical outcomes than the standard therapy. Additionally, we presented a case of a 59-year-old man who presented with severe neurological manifestations and was successfully treated with intravenous immunoglobulin.MethodsThe online databases PubMed and EMBASE were searched.ResultsA total of 1,365 articles were identified. After the deletion of 112 duplicates, 1,253 studies were screened by evaluating the title and abstract, focusing on Hashimoto’s encephalopathy cases where IVIG were used. 846 studies were excluded because they were not relevant to the topic or included pediatric population. Therefore, 407 full-text articles were assessed for eligibility. The final analysis included 14 eligible articles after 393 were excluded (irrelevant texts, not written in English, full-text not available). In the majority of the selected case-reports, IVIG was associated with a good outcome, sometimes even with dramatic improvements in patient’s status.ConclusionIn last years, intravenous immunoglobulin therapy proved its utility in Hashimoto’s encephalopathy’s treatment, being a well tolerated therapy associated with remarkable improvement in patient’s status. Further research is still needed in order to define the optimal treatment protocol for Hashimoto’s encephalopathy and to establish if intravenous immunoglobulin can also be used as a first-line therapy, alone or in combination with steroids.

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“…간이식 수술 후 발생하는 섬망 등 신경학적 합병증은 대략 13%에서 42% 정도로 빈번하게 발생하는데 [1,2] 수술 후 사망률 과 합병증의 이환율과의 연관성이 높고 중환자실 체류기간과 재 원 기간이 연장되어 의료비 또한 증가하게 된다 [3]. 술 후 섬망 에 영향을 주는 요인으로 술 후 신체 억제대, 대사 및 전해질 이 상, 마취제, anticholinergics, benzodiazepine, 마약성 진통제 및 항파킨슨 약과 같은 약물 사용, 부적절한 술 후 통증 조절, 술 중 실혈량이나 수혈량, 술 후 낮은 알부민 수치나, 헤마토크리트 30% 미만, 산소 결핍증 등이 알려져 있다 [4][5][6][7][8].…”

Section: 서 론unclassified

The effect of early extubation on postoperative delirium in patients with liver transplantation: a propensity score matching analysis

Choi

et al. 2019

Anesth Pain Med

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Background: Maintenance of tracheal intubation is associated with use of sedatives, stress due to mechanical ventilation, or respiratory complications. The aim of this study is to compare the incidence of delirium between early and late extubation groups after liver transplantation (LT).Methods: Medical records from 247 patients who received LT from January 2010 to July 2017 in a single university hospital were retrospectively reviewed. Patients were divided with 2 groups: Those who underwent early extubation after LT (E group, n = 52) and those who underwent extubation within few hours of intensive care unit (ICU) admission after surgery (C group, n = 195). The patients' demographic data, perioperative managements and postoperative complications were collected. Early extubation was defined as performing extubation in the operating room after LT. A propensity score matching analysis was performed to reduce the effects of selection bias.Results: Among them, 4/52 (7.69%) in E group and 30/195 (15.38%) in C group occurred postoperative delirium after LT, respectively (P = 0.180). After propensity score matching, there was no difference of the period of hospitalization in ICU (P = 0.961), time to discharge after surgery (P = 0.117) and incidence of delirium between groups (P = 1.000).Conclusions: Although this study is a retrospective study and limited by the small number of subjects, early extubation does not affect the incidence of delirium after LT. Therefore, further prospective studies on this were needed.

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Hashimoto’s Encephalopathy Presenting with Progressive Cerebellar Ataxia

Cited by 5 publications

References 13 publications

Cerebellar Ataxia in the Setting of Hashimoto’s Thyroiditis: A Case Report

Cerebellar Ataxia in the Setting of Hashimoto’s Thyroiditis: A Case Report

The use of intravenous immunoglobulin in the treatment of Hashimoto’s encephalopathy: case based review

The effect of early extubation on postoperative delirium in patients with liver transplantation: a propensity score matching analysis

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