Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT): Characteristics, treatment and outcome in 251 cases from the literature

Laurent, Charlotte; Capron, Jean; Quillerou, Bluenn; Thomas, Guy; Alamowitch, Sonia; Fain, Olivier; Mékinian, A.

doi:10.1016/j.autrev.2016.09.008

Cited by 162 publications

(170 citation statements)

References 32 publications

Supporting

Mentioning

146

Contrasting

Unclassified

Order By: Relevance

“…SRE has been observed in or associated with a growing number of non-vasculitic cases such as SRE associated with autoimmune thyroiditis (SREAT), Alzheimer’s disease, Creutzfeldt-Jakob disease and cholesterol emboli 1–3. In patients with SREAT, case reports and case series have reported substantial improvement with steroid administration 4. Based on our review of the medical literature, this effect has not been previously described in patients with hypoglycaemic encephalopathy.…”

Section: Introductionmentioning

confidence: 68%

Case of steroid-responsive encephalopathy from hypoglycaemia

Mathur¹,

Rajabi²,

Schroeder

et al. 2017

BMJ Case Reports

View full text Add to dashboard Cite

Hypoglycaemic encephalopathy is a feared complication in the management of patients with diabetes mellitus. We report on a 73-year-old woman with type 1 diabetes managed with an insulin pump who presented unresponsive after an inappropriate insulin bolus. The patient had minimal improvement in her neurological status over 8 days. After administration of 1 g intravenous methylprednisolone, she had dramatic neurological improvement including successful extubation and discharge from the intensive care unit. Steroid responsive encephalopathy is increasingly recognised in practice and literature. However, to the best of our knowledge, this is the first case of hypoglycaemic encephalopathy that responded to high-dose steroids.

show abstract

Section: Introductionmentioning

confidence: 68%

Case of steroid-responsive encephalopathy from hypoglycaemia

Mathur¹,

Rajabi²,

Schroeder

et al. 2017

BMJ Case Reports

View full text Add to dashboard Cite

show abstract

“…[12–16] Various symptoms are used to define clinical subtypes of HE, such as the Creutzfeldt–Jakob disease-like form and the cerebellar ataxic form. [22–24] However, the diversity of symptoms and the high prevalence of antithyroid antibodies in healthy populations may make the diagnosis of HE difficult.…”

Section: Discussionmentioning

confidence: 99%

“…[11,12] HE is an autoimmune encephalopathy associated with Hashimoto thyroiditis, also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis. [13–16] Our recent case report described a patient with autoimmune LE and serum anti-NAE antibodies who was diagnosed with HE based on positive serum antithyroid antibodies and responsiveness to immunotherapy, [17] suggesting that patients with LE and anti-NAE antibodies could respond to immunotherapy and that LE associated with anti-NAE antibodies may be a clinical subtype of HE.…”

Section: Introductionmentioning

confidence: 99%

Limbic encephalitis associated with anti-NH2-terminal of α-enolase antibodies

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Therefore, we diagnosed the patient with SREAT, which is typically characterized by seizures (47%), confusion (46%), memory disturbances (43%), disordered speech (37%), gait disturbance (27%), delusions (25%), myoclonic jerks (22%), and depression (12%) (6). Clinical manifestations of isolated schizophreniform syndromes have been described for individual cases in the literature (8–12).…”

Section: Discussionmentioning

confidence: 99%

“…Immunological encephalopathies can be associated with antibodies against thyroid tissue, such as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) with antithyroid peroxidase antibodies, intracellular onconeural or synaptic antigens, such as limbic encephalitis with anti-Hu antibodies, or neuronal cell surface antigens, such as autoimmune encephalitis due to anti- N -methyl- d -aspartate receptor (NMDAR) antibodies (2, 3). SREAT should be considered in the context of neuropsychiatric symptoms, autoimmune thyroiditis, increased thyroid antibodies, such as antithyroid peroxidase or anti-thyroglobulin antibodies, and other organic alterations [e.g., blood–brain barrier dysfunction in the cerebrospinal fluid, abnormal encephalopathic patterns as identified by an electroencephalogram (EEG), and non-specific white matter lesions as identified by cerebral magnetic resonance imaging (cMRI) (4–6)]. SREAT can mimic schizophreniform and other psychiatric syndromes (3, 7).…”

Section: Introductionmentioning

confidence: 99%

Steroid-Responsive Chronic Schizophreniform Syndrome in the Context of Mildly Increased Antithyroid Peroxidase Antibodies

et al. 2017

View full text Add to dashboard Cite

BackgroundSchizophreniform syndromes can be divided into primary forms from polygenic causes or secondary forms due to immunological, epileptiform, monogenic, or degenerative causes. Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is a secondary immunological form associated with increased thyroid antibodies, such as antithyroid peroxidase antibodies and shows a good response to corticosteroids.Case presentationWe present the case of a 41-year-old woman suffering from a schizophreniform syndrome. Starting at the age of 35, she developed psychotic exacerbations with formal thought disorder, acoustic hallucinations, cenesthopathic experiences, and loss of ego boundaries. At the same time, she began to suffer from chronic sexual delusions and olfactory hallucinations, which did not respond to neuroleptic medication. Her levels of antithyroid peroxidase antibodies were slightly increased, and the blood–brain barrier was disturbed. An electroencephalogram (EEG) showed intermittent generalized slowing, and cerebral magnetic resonance imaging (cMRI) depicted mild temporolateral atrophy. High-dose corticosteroid treatment led to convincing improvement of attentional performance and the disappearance of delusions and olfactory hallucinations.ConclusionSREAT can mimic typical symptoms of schizophreniform syndromes. The increased titer of antithyroid peroxidase antibodies in combination with the EEG slowing, blood–brain barrier dysfunction, and the cMRI alterations were the basis for suspecting an immunological cause in our patient. Chronic delusions, olfactory hallucinations, and cognitive deficits were successfully treated with corticosteroids. The occurrence of secondary immunological forms of schizophreniform syndromes demonstrates the need for innovative immunosuppressive treatment options.

show abstract

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT): Characteristics, treatment and outcome in 251 cases from the literature

Cited by 162 publications

References 32 publications

Case of steroid-responsive encephalopathy from hypoglycaemia

Case of steroid-responsive encephalopathy from hypoglycaemia

Limbic encephalitis associated with anti-NH2-terminal of α-enolase antibodies

Steroid-Responsive Chronic Schizophreniform Syndrome in the Context of Mildly Increased Antithyroid Peroxidase Antibodies

Contact Info

Product

Resources

About