Abstract Details

Title Steroid-Responsive Encephalopathy Presenting as New-onset Seizures and Psychosis: A Case Report

Topic Neurohospitalist

Presentation(s) P8 - Poster Session 8 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-001

Objective Presented here is the case of a 54-year-old male with a history of testicular cancer, who was admitted to the Department of Neurology with three months of seizures and acute psychosis. After exhaustive evaluations, including anti-thyroid antibody tests, a diagnosis of SREAT was suspected. The patient exhibited remarkable improvement within days of initiating treatment with high-dose steroids and intravenous immunoglobulin (IVIG), confirming the diagnosis.

Background Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also known as Hashimoto’s Encephalopathy (HE), is an exceptionally rare autoimmune condition characterized by elevated serum anti-thyroid antibodies in the context of new-onset encephalopathy. Despite its rarity, prompt recognition and diagnosis are crucial due to its potential for swift and significant improvement with immunomodulating therapies.

Design/Methods The diverse presentation of SREAT, including seizures, psychosis, and neurological deficits, often complicates diagnosis. Notably, the diagnostic criteria, involving the presence of anti-thyroid antibodies in suspected autoimmune encephalitis, remain controversial. However, the rapid response to immunomodulating therapies, as observed in this case, strengthens the argument for the accuracy of the diagnosis.

Results SREAT’s rarity and variable symptoms emphasize the need for heightened clinical suspicion when encountering patients with unexplained seizures or psychosis. Including serum anti-thyroid antibodies in the initial diagnostic workup could facilitate faster diagnosis, enabling prompt treatment initiation.

Conclusions In this instance, the patient's swift diagnosis and treatment initiation highlight the potential benefits of integrating anti-thyroid antibody testing into the diagnostic process, expediting accurate identification and ensuring timely intervention for this challenging and often misunderstood condition.

Authors/Disclosures
Yasaman Pirahanchi, MD (Brigham and Women's Hospital) PRESENTER	Dr. Pirahanchi has nothing to disclose.
Scott MacFarlane	Mr. MacFarlane has nothing to disclose.

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