MRI Findings of Two Patients With Hashimoto Encephalopathy

Jegatheeswaran, Vibeeshan; Chan, Michael W.Y.; Chen, Yingming A

doi:10.7759/cureus.15697

Cited by 6 publications

(2 citation statements)

References 18 publications

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“…Diagnostic testing findings in Hashimoto's encephalopathy have been reported as non-specific with either normal MRI or non-specific signal abnormalities. 9 Our patient demonstrated striking vascular abnormalities suggestive of vasculitis of large and medium arteries. Severe atrophy of the caudate and temporal lobes likely reflects a prolonged cerebral inflammation secondary to an occult long-standing Hashimoto's encephalopathy.…”

Section: Discussionmentioning

confidence: 53%

Hashimoto's Encephalopathy Masquerading as Rapidly Progressive Dementia and Extrapyramidal Failure

Aladdin

Shirah

2022

JNRP

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Hashimoto's encephalopathy is a rare immune-mediated disorder characterized by subacute encephalopathy with elevated thyroid antibodies. Hashimoto's encephalopathy is also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis. We report a rare presentation of Hashimoto's encephalopathy presenting with acute neuropsychiatric disturbances, rapidly progressive dementia, seizures, and extrapyramidal failure. Neuroimaging revealed multifocal vasculitides of major cerebral vessels that support the autoimmune vasculitic theory as the underlying pathogenesis for Hashimoto's encephalopathy. Unfortunately, permanent irreversible cerebral damage has already ensued before her presentation to our center, which rendered steroid therapy ineffective. Serological testing for Hashimoto's thyroiditis must be in the investigation of all rapidly progressive dementias as early diagnosis and timely management of autoimmune thyroiditis may salvage sizable and eloquent cerebral tissues. The rarity of the condition should not preclude the investigation of Hashimoto's disease even in the presence of normal levels of thyroid hormones. Delayed diagnosis may result in irreversibly catastrophic encephalopathy in patients who once presented with potentially curable dementia.

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Section: Discussionmentioning

confidence: 53%

Hashimoto's Encephalopathy Masquerading as Rapidly Progressive Dementia and Extrapyramidal Failure

Aladdin

Shirah

2022

JNRP

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“…The main EEG finding consists in slow wave abnormalities, but epileptiform abnormalities, focal slowing, triphasic waves and photic stimulation induced discharges can also be found ( 69 , 70 ). Brain MRI is usually normal, although in some cases, non-specific findings are observed, such as white matter changes, edema, atrophy, and ischemic lesions ( 71 ). Existing literature demonstrates that some of these abnormalities can be reversible after treatment ( 72 ).…”

Section: Discussionmentioning

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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Miscellaneous Topics in Disorders of Endocrine Glands

2023

Endocrinology

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MRI Findings of Two Patients With Hashimoto Encephalopathy

Abstract: Jegatheeswaran et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 6 publications

References 18 publications

Hashimoto's Encephalopathy Masquerading as Rapidly Progressive Dementia and Extrapyramidal Failure

Hashimoto's Encephalopathy Masquerading as Rapidly Progressive Dementia and Extrapyramidal Failure

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

Miscellaneous Topics in Disorders of Endocrine Glands

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