Abstract
BACKGROUND: Hashimoto encephalopathy (HE) is a poorly understood and often misdiagnosed entity with variable clinical spectrum. There are many uncertainties that still remain about this condition and the pathological significance of thyroid peroxidase (TPO) antibody. OBJECTIVE: To characterize the clinical, laboratory and radiologic findings in patients with HE. DESIGN: Retrospective analysis of clinical features and diagnostic test data. MAIN OUTCOME MEASURES: Clinical features, laboratory, radiologic, electroencephalography (EEG) findings associated with HE and therapeutic outcome. RESULTS: Thirteen consecutive patients were identified as having HE. The median age at onset was 48.5 years (range, 19-62 years). There was a female preponderance (76.9%). Clinical manifestations were cognitive impairment and behavioral changes in 10 (76.9%), sleep disturbance in 9 (69.2%), seizures in 6 (46.1%), headache in 4 (30.8%), psychosis or paranoia in 5 (38.5%), transient symptoms in 6 (46.1%), myoclonus in 4 (30.8%), ataxia or gait disorder in 4 (30.8%). The most frequent laboratory abnormalities were increased TPO (n = 13) in all cases, increased thyroid stimulating hormone levels (n = 6), and increased erythrocyte sedimentation rate (n = 5). The cerebrospinal fluid protein level was elevated in 8 of 9 patients (88.8%). Magnetic resonance imaging abnormalities were present in 2 patients (15.4%). EEG changes were seen in 7 patients (53.8%). All but two patients showed significant therapeutic benefit with steroids. CONCLUSIONS: HE has a wide range of clinical, laboratory, and radiologic findings. All patients with an unexplained encephalopathy should be screened for this condition as treatment response is excellent. To the best of our knowledge, this is the largest single center clinical series of HE from the Indian subcontinent.
Copyright
Association for Helping Neurosurgical Sick People. This is an open
access article published by Thieme under the terms of the Creative
Commons Attribution-Non Derivative-Non Commercial License, permitting
copying and reproduction so long as the original work is given
appropriate credit.
Contents may not be used for commercial purposes, or
adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/
)
This is an open-access article distributed under the terms of the
Creative Commons Attribution-Non Commercial-No Derivatives License, which
permits unrestricted reproduction and distribution, for non-commercial
purposes only; and use and reproduction, but not distribution, of
adapted material for non-commercial purposes only, provided the original
work is properly cited.