Nonconvulsive status epilepticus in the course of Hashimoto’s encephalopathy – case report
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Oddział Neurologii, Wojewódzki Szpital Specjalistyczny Megrez Sp. z o.o. w Tychach
Agata Rauszer-Szopa   

Oddział Neurologii, Wojewódzki Szpital Specjalistyczny Megrez Sp. z o.o. w Tychach, ul. Edukacji 102, 43-100 Tychy
Ann. Acad. Med. Siles. 2019;73:226–235
Hashimoto’s encephalopathy (HE) is a rare neurologic syndrome that can accompany Hashimoto’s disease or occur independently. The spectrum of symptoms – broad and uncharacteristic – hinders the diagnostic process. Hashimoto’s encephalopathy can resemble every kind of delirium disease and rapidly progressive dementia, which is why the case report presented in the paper is significant for doctors of all specialisations. The majority of patients are in the euthyroid state. The course of the illness may be acute stroke-like or with psychiatric symptoms and epileptic seizures. HE is most often diagnosed by excluding other causes of neurological disorders, and by identifying encephalopathy and high levels of thyroid peroxidase and thyreoglobulin antibodies, which is crucial for a quick and accurate diagnosis. Cerebro-spinal fluid examination and electroencephalography are also very useful. Therapy with steroids is the treatment of choice, however, if no clinical improvement is apparent or resistance to steroids occurs, other methods like plasmapheresis, immunoglobulins, immunosuppression or biological drugs are used. Quick and accurate diagnosis followed by appropriate treatment ensures a promising prognosis.
Wirkowski E., Zajkowska A., Tarasiuk J., Kułakowska A. Encefalopatia Hashimoto. Neurologia po Dyplomie 2016; 04: 42–46.
Creutzfeldt C.J., Haberl R.l. Hashimoto encephalopathy: a do-not miss in the differential diagnosis of dementia. J. Neurol. 2005; 252(10): 1285–1287.
Steczkowska M., Skowronek-Bała B., Wesołowska E. Neurofizjologiczna ocena dwóch pacjentek z encefalopatią Hashimoto. Prz. Lek. 2011; 68(11): 1154–1156.
Ochi H., Horiuchi I., Araki N., Toda T., Araki T., Sato K., Murai H., Osoegawa M., Yamada T., Okamura K., Ogino T., Mizumoto K., Yamashita H., Saya H., Kira J. Proteonic analysis of human brain identifies alpha-enolase as a novel autoantigen is hashimotos’s encephalophaty. FEBS Letters 2002; 528: 197–202, doi: 10.1016/s0014-5793(02)03307-0.
Chong J.Y., Rowland L.P., Utiger R.D. Hashimoto encephalopathy: syndrome or myth? Arch. Neurol. 2003; 60(2): 164–171, doi: 10.1001/archneur.60.2.164.
Schiess N., Pardo C.A. Hashimoto’s encephalopathy. Ann. NY Acad. Sci. 2008; 1142: 254–265, doi: 10.1196/annals.1444.018.
Santra G., De D., Phaujdar S., Rudra A., Dutta P.S. Hashimoto’s encephalopathy. J. Assoc. Physicians India 2012; 60: 48–51.
Payer J., Petrovic T., Lisy L., Langer P. Hashimoto Encephalopathy: A Rare Intricate Syndrome. Int. J. Endocrinol. Metab. 2012; 10(2): 506–514, doi: 10.5812/ijem.4174.
Ferlazzo E., Raffaele M., Mazzu I., Pisani F. Recurrent status epilepticus as the main feature of Hashimoto’s encephalopathy. Epilepsy Behav. 2006; 8(1): 328–330, doi: 10.1016/j.yebeh.2005.11.005.
Cantón A., de Fàbregas O., Tintoré M., Mesa .J, Codina A., Simó R. Encephalopathy associated to autoimmune thyroid disease: a more appropriate term for an underestimated condition? J. Neurol. Sci. 2000; 176(1): 65–69, doi: 10.1016/s0022-510x(00)00302-6.
Tafakhori A., Siroos B., Ghabaii M., Harirchain M.H., Tajdini M., Garg S.K. Hashimoto Encephalopathy in Case of Progressive Cognitive Impairment; a Case Report. Emerg. 2014; 2(3): 144–146.
Maitland C. Hashimoto`s Encephalopathy. 211–216. https://webcache.googleusercon... q=cache:366FHQCV7pwJ:https://collections.lib.utah.e... [dostęp: 19.12.2019].
Szyska-Skrobot D., Kowalska A., Jamrozik Z. Encefalopatia Hashimoto – opis przypadku. Endokrynol. Pol. 2008; 59(2): 168–171.
Schaw P.J., Walls T.J., Newman P.K., Cleland P.G. Cartlidge N.E. Hashimoto’s encephalopathy:a steroid-responsive disorder associated with high anti-thyroid antibody titers — report of 5 cases. Neurology 1991; 41(2(Pt 1): 228–233, doi: 10.1212/wnl.41.2_part_1.228.
Ferracci F., Bertiato G., Moretto G. Hashimoto’s encephalopathy: epidemiologic data and pathogenetic considerations. J. Neurol. Sci. 2004; 217(2): 165–168, doi: 10.1016/j.jns.2003.09.007.
Nolte K.W., Unbehaun A., Sieker H., Kloss T.M., Paulus W. Hashimoto encephalopathy: a brainstem vasculitis? Neurology 2000; 54(3): 769–770, doi: 10.1212/wnl.54.3.769.
Canelo-Aybar C., Loja-Oropeza D., Cuadra-Urteaga J., Romani-Romani F. Hashimoto’s encephalopathy presenting with neurocognitive symptoms: a case report. J. Med. Case Rep. 2010; 4: 337, doi: 10.1186/1752-1947--4-3337.
Peschen-Rosin R., Schabet M., Dichgans J. Manifestation of Hashimoto’s encephalopathy years before onset of thyroid disease. Eur. Neurol. 1999; 41(2): 79–84.
Cheriyath P., Nookala V., Srivastava A., Qazizadeh S., Fischman D. Acute confusional state caused by Hashimoto’s encephalopathy in a patient with hypothyroidism: a case report. Cases J. 2009; 2: 7967, doi: 10.4076/1757-1626-2-7967.
Papuć E., Kurys-Denis E., Krupski W., Stelmasiak Z. Hashimoto’s encephalopathy-rare but reversible cause of dementia or psychosis. Curr. Probl. Psychiatry 2011; 12(4): 495–497.
Castillo P.R., Boeve B.F., Caselli J.R. Steroid-responsive encephalopathy associated with thyroid autoimmunity: clinical and laboratory findings. Neurol. 2002; 58(Suppl 3): A248.
White M.L., Hadley W.L., Zhang Y., Dogar M. A. Analysis of central nervous system vasculitis with diffusion-weighted imaging and apparent diffusion coefficient mapping of the normal-appearing brain. AJNR Am. J. Neuroradiol. 2007; 28(5): 933–937.
Raouf A.A., Tamagno G. Encephalopathy associated with autoimmune thyroid disease. EMJ Neurol. 2014; 1: 72–77.
Ferracci F., Carnevale A. The neurological disorder associated with thyroid autoimmunity. J Neurol. 2006; 253(8): 975–984, doi: 10.1007/s00415-006-0170-7.
Vander T., Hallevy C., Alsaed I., Valdman S., Ifergane G., Wirguin, I. 14-3-3 protein in the CSF of a patient with Hashimoto’s encephalopathy. J. Neurol. 2004; 251(10): 1273–1274, doi: 10.1007/s00415-004-0515-z.
Hernándle-Echebarria L.H., Saiz A., Graus F., Tejada J., García J.M., Clavera B., Fernández F. Detection of 14-3-3 protein in the CSF of a patient with Hashimoto’s encephalopathy. Neurology 2000; 54(7): 1539–1540, doi: 10.1212/wnl.54.7.1539.
Mocellin R., Walterfang M., Velakoulis D. Hashimoto’s Encephalopathy-Epidemiology, Pathogenesis and Management. CNS Drugs 2007; 21(10): 799––811, doi: 10.2165/00023210-200721100-00002.
Brusa L., Panella M., Koch G., Bernardi G., Massa R. Hashimoto’s encephalopathy presenting with musical hallucinosis. J. Neurol. 2003; 250 (5): 627–628, doi: 10.1007/s00415-003-1058-4.
Sellal F., Berton C., Andriantseheno M., Clerc C. Hashimoto’s encephalopathy: exacerbations associated with menstrual cycle. Neurology 2002; 59(10): 1633–1635, doi: 10.1212/01.wnl.0000034178.22733.75.
Zhu Y., Yang H., Xiao F. Hashimoto’s encephalopathy: a report of three cases and relevant literature reviews. Int. J. Clin. Exp. Med. 2015; 8(9): 16817–16826.
Chen C., Chand P., Iyadurai S., Scaduto M., Varvares M. Mixed Clinical Response After Total Thyroidectomy in Two Patients with Hashimoto’s Encephalopathy. Thyroid Disorders Ther. 2013; 2(3): 131, doi: 10.4172/2167-7948.1000131.