Hypothalamic Encephalitis with Bradycardia.

Abstract

A 74-year-old man developed fever, somnolence, hyponatremia, and life-threatening sinus bradycardia for three weeks. He showed a slight elevation of lymphocyte count and protein level in the cerebrospinal fluid. A brain CT scan revealed a diffuse low density area around the hypothalamus which was identified as a high intensity signal by flair MR imaging. Marked sinus bradycardia developed with no abnormality in the echocardiograph or cardiac enzymes. Over the next 6 weeks he became alert and normal sinus rhythm resumed. The results of endocrine tests were compatible with hypothalamic insufficiency with partial hypopituitarism and the syndrome of inappropriate secretion of ADH. (Internal Medicine 40: 805-807, 2001)

Autonomic alterations as a clinical manifestation of encephalopathy associated with autoimmune thyroid disease

“…To the best of our knowledge, no previous reports of neurovegetative/autonomic alterations have been ever described in EAATD. On the contrary, a few cases of bradycardia and hypothermia secondary to infectious or autoimmune hypothalamic or limbic encephalitis have been reported [20][21][22][23]. In particular, hypothermia and haemodynamic changes consistent with autonomic dysfunction have been observed in patients with anti-Ma-2 Abs, anti-NMDA receptor Abs, and anti-VGKC Abs, the latter targeting usually the hippocampus and the mesial temporal lobe [24,25].…”