Abstract Details

Title Hashimoto’s Encephalopathy: A Spectrum Disorder?

Topic General Neurology

Presentation(s) P16 - Poster Session 16 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-007

Objective To present three cases of Hashimoto's encephalopathy, highlighting the spectrum of clinical features encountered.

Background

Hashimoto’s encephalopathy, also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), is an uncommon syndrome with diverse clinical presentations and is often under-recognized. It can present with a multitude of symptoms including myoclonus, seizures, encephalopathy and coma. Here, we present three cases diagnosed as SREAT, with variable clinical presentations.

Design/Methods We present three cases diagnosed with Hashimoto's encephalopathy in Hamad medical corporation, comparing their clinical presentation, Laboratory findings and treatment received.

Results First patient was a 57-year old male Sudanese with no previous medical problem, who presented with multiple episodes of bilateral high frequency, low amplitude tremor over a course of 1 month, which progressed later to seizures, confusion and eventually coma. Second patient was a 47-year old Indian male brought to the emergency department after he suffered from an episode of severe and persistent headache followed by generalized tonic-clonic seizures .He also showed some cognitive impairment. Third Patient, a 45-year Bangladeshi male with no previous medical problem, presented with 2 week history of abnormal behavior, aggression, acute confusion, persecutory delusion and auditory hallucinations. All 3 patients had elevated CSF protein. In addition, all of them had positive anti-TPO antibodies and 2 of them also had positive anti-thyroglobulin antibody. The second patient had an abnormal MRI showing feature of encephalitis involving bilateral frontal lobes; only one patient, the third, had overt hypothyroidism. They all had marked improvement and resolution of their symptoms following steroids therapy, in combination with IVIG in the first patient; The third patient required thyroid replacement therapy. Resolution of the MRI abnormalities was seen in the second patient.

Conclusions

Hashimoto’s encephalopathy (SREAT) is an uncommon, reversible condition with wide spectrum of clinical manifestations including cognitive, neuropsychiatric, seizures, myoclonus, movement disorders like tremors, and coma.

Authors/Disclosures
Ali M. Al-Salahat, MBBS (Creighton University - Neurology Program) PRESENTER	Dr. Al-Salahat has nothing to disclose.
Rola Khodair, MBBS (Hamad General Hospital)	Dr. Khodair has nothing to disclose.
Khansa S. Tamboli, Jr., MD (Hamad Medical Corporation)	Dr. Tamboli has nothing to disclose.
Rasha Aldabbagh, MD (Hamad medical Corporation)	No disclosure on file
Musab Ali, MD (Neurology Department Hamad General Hospital)	Dr. Ali has nothing to disclose.
Boulenouar Mesraoua, MD, FAAN (Hamad Medical Corporation)	Dr. Mesraoua has nothing to disclose.
Yasir Ali, MD, FAAN (Hamad Medical Corporation)	Dr. Ali has nothing to disclose.

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