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Strzałkowska B, Strzelczyk J, Dawidowicz M, Kula A, Mielcarska S, Szarek R, Świętochowska E. Brain disorders in euthyroid Hashimoto's thyroiditis patients. Clin Neurol Neurosurg 2024; 245:108519. [PMID: 39216416 DOI: 10.1016/j.clineuro.2024.108519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 08/22/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
Hashimoto's thyroiditis (HT) is an autoimmune disorder characterized by the destruction of thyroid follicular cells by thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb), leading to hypothyroidism. Hashimoto's encephalopathy (HE) is associated with elevated levels of antithyroid antibodies. An important question is whether brain alterations precede the development of HE and are present in euthyroid patients with HT, and what pathomechanisms could be responsible for these changes. A PubMed search was conducted to identify studies addressing this issue. Numerous questionnaire studies confirmed impairments in cognitive functioning, mental and physical health, and overall well-being in euthyroid HT patients. Additionally, some imaging and mouse model studies indicate that euthyroid patients with HT likely have central nervous system alterations. Antibodies may be involved in the development of these changes. Some research suggests the role of TPOAb and TgAb, while other studies highlight the involvement of coexisting antibodies. Determining whether antibodies are assessed in serum or cerebrospinal fluid (CSF) is crucial. Antibody-specific indices (ASIs) can differentiate between antibodies passively diffusing from the serum and brain-derived antibodies, and could serve as biomarkers for brain alterations in HT patients. Much more research is needed to identify reliable biomarkers and treatments that could improve the quality of life for these patients.
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Affiliation(s)
- Bogumiła Strzałkowska
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 19 Zabrze 41-800, Poland.
| | - Janusz Strzelczyk
- Division of Endocrinology, Department of Pathophysiology and Endocrinology, Silesian Medical University, Ceglana 35, Katowice 40-514, Poland.
| | - Miriam Dawidowicz
- Department of Oncological Surgery, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice 41-808, Poland.
| | - Agnieszka Kula
- Department of Oncological Surgery, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice 41-808, Poland.
| | - Sylwia Mielcarska
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 19 Zabrze 41-800, Poland.
| | - Rafał Szarek
- Department of Microbiology and Immunology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 19 Jordana, Zabrze 41-800, Poland.
| | - Elżbieta Świętochowska
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 19 Zabrze 41-800, Poland.
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2
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Schenck LAM, McCracken HT, Andrasik F, Baughman BC. Hashimoto encephalopathy: a literature review and case report with comprehensive neuropsychological evaluation. Clin Neuropsychol 2024:1-20. [PMID: 39154259 DOI: 10.1080/13854046.2024.2388905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024]
Abstract
Objective: Hashimoto's encephalopathy (HE), a rare immune-mediated disorder, manifests as altered mental state, cognitive and psychological dysfunction, seizures, and myoclonus. Little is known, however, about the neuropsychological profiles of individuals with HE due to the sparse amount of research. This report overviews HE, summarizes findings from available published neuropsychological evaluations, and details neuropsychological examinations of a 57-year-old White woman with a confirmed HE diagnosis evidencing persistent neuropsychological impairment at two discrete timepoints. Method: An extensive literature search was conducted on PubMed and Google Scholar for studies including neuropsychological evaluations of HE cases. Our neuropsychological evaluation included chart review, diagnostic clinical interview, performance-based neurocognitive assessment, and measures of personality and psychopathology. Results: Our assessment revealed a largely subcortical pattern of neurocognitive impairment and impactful neuropsychiatric symptoms that, together, significantly impacted the patient's quality of life and functional status. The patient's performance improved during a six-month re-evaluation within the domains of cognition, psychological functioning, and functional independence. Conclusions: This article highlights the complexity and possible long-term sequela of HE. Complex medical history (including autoimmune disorders) and psychiatric presentation at onset may be factors related to longer-term cognitive dysfunction. Neuropsychology and psychology can serve important and unique roles in assessing long-term functioning and response to treatment in such cases.
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Affiliation(s)
- Lauren A-M Schenck
- Department of Psychology, The University of Memphis, Memphis, TN, USA
- Department of Neuropsychology, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN, USA
| | - Halle T McCracken
- Department of Neuropsychology, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN, USA
- Department of Psychology, The University of Mississippi, University, MS, USA
| | - Frank Andrasik
- Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Brandon C Baughman
- Department of Neuropsychology, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
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3
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Hussain MS, Gupta G, Samuel VP, Almalki WH, Kazmi I, Alzarea SI, Saleem S, Khan R, Altwaijry N, Patel S, Patel A, Singh SK, Dua K. Immunopathology of herpes simplex virus-associated neuroinflammation: Unveiling the mysteries. Rev Med Virol 2024; 34:e2491. [PMID: 37985599 DOI: 10.1002/rmv.2491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/21/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
The immunopathology of herpes simplex virus (HSV)-associated neuroinflammation is a captivating and intricate field of study within the scientific community. HSV, renowned for its latent infection capability, gives rise to a spectrum of neurological expressions, ranging from mild symptoms to severe encephalitis. The enigmatic interplay between the virus and the host's immune responses profoundly shapes the outcome of these infections. This review delves into the multifaceted immune reactions triggered by HSV within neural tissues, intricately encompassing the interplay between innate and adaptive immunity. Furthermore, this analysis delves into the delicate equilibrium between immune defence and the potential for immunopathology-induced neural damage. It meticulously dissects the roles of diverse immune cells, cytokines, and chemokines, unravelling the intricacies of neuroinflammation modulation and its subsequent effects. By exploring HSV's immune manipulation and exploitation mechanisms, this review endeavours to unveil the enigmas surrounding the immunopathology of HSV-associated neuroinflammation. This comprehensive understanding enhances our grasp of viral pathogenesis and holds promise for pioneering therapeutic strategies designed to mitigate the neurological ramifications of HSV infections.
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Affiliation(s)
- Md Sadique Hussain
- School of Pharmaceutical Sciences, Jaipur National University, Jaipur, Rajasthan, India
| | - Gaurav Gupta
- Centre for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Kuthambakkam, India
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
- School of Pharmacy, Suresh Gyan Vihar University, Jaipur, India
| | - Vijaya Paul Samuel
- Department of Anatomy, RAK College of Medicine, RAK Medical and Health Sciences, Ras Al Khaimah, United Arab Emirates
| | - Waleed Hassan Almalki
- Department of Pharmacology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sami I Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Shakir Saleem
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Ruqaiyah Khan
- Department of Basic Health Sciences, Deanship of Preparatory Year for the Health Colleges, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Najla Altwaijry
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Samir Patel
- Department of Pharmaceutical Chemistry and Analysis, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat, India
| | - Archita Patel
- Department of Pharmaceutical Chemistry and Analysis, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
| | - Kamal Dua
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Broadway, New South Wales, Australia
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Yamashita S, Tsumura M, Taira A, Mizuno Y, Uehara T, Tomura M, Murai H. Steroid-responsive ocular flutter with truncal ataxia and anti-amino-terminal of α-enolase antibody. J Neurol 2023; 270:5094-5096. [PMID: 37365281 DOI: 10.1007/s00415-023-11843-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Satoshi Yamashita
- Department of Neurology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan.
| | - Makoto Tsumura
- Department of Neurology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Akihiko Taira
- Department of Neurology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Yuri Mizuno
- Department of Neurology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Taira Uehara
- Department of Neurology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Masaki Tomura
- Department of Neurology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Hiroyuki Murai
- Department of Neurology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
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Schneider SA, Tschaidse L, Reisch N. Thyroid Disorders and Movement Disorders-A Systematic Review. Mov Disord Clin Pract 2023; 10:360-368. [PMID: 36949803 PMCID: PMC10026317 DOI: 10.1002/mdc3.13656] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 01/13/2023] Open
Abstract
Background There is overlap between movement disorders and neuroendocrine abnormalities. Objectives and methods To provide a systematic review on the association of thyroid dysfunction and movement disorders. Thyroid physiological function and classical thyroid disorders highlighting typical and atypical manifestations including movement disorders, as well as diagnostic procedures, and treatments are discussed. Results Hypothyroidism may be associated with hypokinetic and hyperkinetic disorders. There is debate whether their concomitance reflects a causal link, is coincidence, or the result of one unmasking the other. Hypothyroidism-associated parkinsonism may resemble idiopathic Parkinson's disease. Hypothyroidism-associated hyperkinetic disorders mainly occur in the context of steroid-responsive encephalopathy with autoimmune thyroiditis, that is, Hashimoto disease, mostly manifesting with tremor, myoclonus, and ataxia present in 28-80%, 42-65% and 33-65% in larger series. Congenital hypothyroidism manifesting with movement disorders, mostly chorea and dystonia, due to Mendelian genetic disease are rare.Hyperthyroidism on the other hand mostly manifests with hyperkinetic movement disorders, typically tremor (present in three quarters of patients). Chorea (present in about 2% of hyperthyroid patients), dystonia, myoclonus, ataxia and paroxysmal movement disorders, as well as parkinsonism have also been reported, with correlation between movement intensity and thyroid hormone levels.On a group level, studies on the role of thyroid dysfunction as a risk factor for the development of PD remain non-conclusive. Conclusions In view of the treatability of movement disorders associated with thyroid disease, accurate diagnosis is important. The pathophysiology remains poorly understood. More detailed case documentation and systematic studies, along with experimental studies are needed.
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Affiliation(s)
| | - Lea Tschaidse
- Medizinische Klinik und Poliklinik IVKlinikum der Universität MünchenMunichGermany
| | - Nicole Reisch
- Medizinische Klinik und Poliklinik IVKlinikum der Universität MünchenMunichGermany
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Maretta M, Lacková A, Wagnerová H, Feketeová E, Gdovinová Z. Steroid responsive encephalopathy associated with autoimmune thyroiditis as a cause of acuteencephalopathy. VNITRNI LEKARSTVI 2023; 69:25-29. [PMID: 37827820 DOI: 10.36290/vnl.2023.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), known as Hashimoto's encephalopathy (HE), represents a heterogeneous group of neurological and neuropsychiatric symptoms associated with a presence of antithyroid antibodies in case of other causes of encephalopathy were excluded. Clinical symptoms most commonly includes acute onset of encephalopathy, behaviour changes and cognitive dysfunction, epileptic seizures as well as cerebellar and extrapyramidal symptoms. Corticoids provides rapid and sustained therapeutic benefit in most patients and only a few patients require other immunosuppressive therapy such as plasmapheresis, intravenous immunoglobulins, or others. We present the cases of two patients with acute onset of encephalopathy, status epilepticus based on SREAT, with rapid improvement after steroid treatment.
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Muacevic A, Adler JR, McFarlane SI. Autoimmune Encephalitis With Autoimmune Diabetes: A Case of Horror Autotoxicus. Cureus 2023; 15:e34268. [PMID: 36855486 PMCID: PMC9968443 DOI: 10.7759/cureus.34268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/28/2023] Open
Abstract
Diagnosing autoimmune encephalitis relies on clinical, radiological, and serological studies. Several autoantibodies have been implicated and recognized, with dozens of potential targets identified in the past 20 years. Despite that progress, some patients with encephalitis present a diagnostic dilemma with a seronegative status. The presence of other autoimmune diseases in a patient with encephalitis should provide a clue to the autoimmune nature of a developing neurological syndrome (cognitive, psychiatric, behavioral, and catatonia). In this report, we describe the case of a young man with type 1 diabetes mellitus who was diagnosed with seronegative autoimmune encephalitis after presenting with catatonia. We describe the lengthy clinical course, the various therapeutic trials, and his clinical outcome and response to B-cell depleting agent. This study also discusses the potential pathophysiologic pathways, providing a rationale for the diagnostic workup and therapeutic options for autoimmune encephalopathy in this case presentation.
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8
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Ozawa M, Sakuta K, Miyagawa S, Yaguchi H. Multiple system atrophy with anti-NAE antibody refractory to immunotherapy: A case report. Clin Neurol Neurosurg 2022; 223:107504. [DOI: 10.1016/j.clineuro.2022.107504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 11/30/2022]
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Hashimoto Encephalopathy—Still More Questions than Answers. Cells 2022; 11:cells11182873. [PMID: 36139446 PMCID: PMC9496753 DOI: 10.3390/cells11182873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
The normal function of the nervous system is conditioned by the undisturbed function of the thyroid gland and its hormones. Comprehensive clinical manifestations, including neurological disorders in Hashimoto’s thyroiditis, have long been understood and, in recent years, attention has been paid to neurological symptoms in euthyroid patients. Hashimoto encephalopathy is a controversial and poorly understood disease entity and the pathogenesis of the condition remains unclear. We still derive our understanding of this condition from case reports, but on the basis of these, a clear clinical picture of this entity can be proposed. Based on a review of the recent literature, the authors present the current view on the subject, discuss controversies and questions that still remain unanswered, as well as ongoing research in this area and the results of our own work in patients with Hashimoto’s thyroiditis.
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Wei C, Shen Y, Zhai W, Shang T, Wang Z, Wang Y, Li M, Zhao Y, Sun L. Hashimoto's encephalopathy with cerebellar ataxia as the main symptom: A case report and literature review. Front Neurol 2022; 13:970141. [PMID: 36081870 PMCID: PMC9445579 DOI: 10.3389/fneur.2022.970141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/29/2022] [Indexed: 12/03/2022] Open
Abstract
Hashimoto's encephalopathy (HE), also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), has a variety of clinical manifestations, with various neuropsychiatric characteristics, including tremors, transient aphasia, seizures, altered consciousness, myoclonus, cognitive impairment, and psychiatric manifestations. The hallmark presenting feature is a non-specific encephalopathy characterized by alteration of mental status and consciousness ranging from confusion to coma and impaired cognitive function, while those with cerebellar ataxia as the main manifestation is rare. We reported a case of Hashimoto's encephalopathy with cerebellar ataxia as the main manifestation, elevated anti-thyroid antibodies (anti-TPO/TG), and normal thyroid function. The symptoms of cerebellar ataxia improved after steroid treatment. Meanwhile, we reviewed the clinical features of 20 representative cases of HE with cerebellar ataxia as the core symptoms. In conclusion, based on our case findings and literature review, the diagnosis of HE should be suspected in cases of encephalopathy without an obvious cause, to quickly start an effective treatment.
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Chelikani V, Rao DN, Balmuri S, Arida AK. A Rare Case of Hashimoto’s Encephalopathy With Mosaic Turner Syndrome. Cureus 2022; 14:e28215. [PMID: 36158323 PMCID: PMC9485009 DOI: 10.7759/cureus.28215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 12/02/2022] Open
Abstract
Mosaicism in Turner syndrome (TS) is a 20%-30% occurrence, with 45, X plus at least another cell line. The haploinsufficiency of the X chromosome is usually responsible for the higher risk of autoimmunity in TS, exhibiting mainly as thyroiditis, type 1 diabetes, etc. Though Hashimoto’s thyroiditis is commonly seen in patients with TS, the concurrence of encephalopathy in these patients is significantly rare and has not been reported. We present a case of a young female with mosaic TS who presented with altered mental status. The initial workup was negative for stroke and pulmonary embolism and cerebrospinal fluid (CSF) analysis did not show any infectious etiology. Thyroid peroxidase (TPO) antibodies (Abs) and thyroglobulin Abs were elevated. As the patient’s mental status deteriorated, there was a concern for Hashimoto’s encephalopathy (HE), hence the patient was started on high-dose IV steroids. Within 24 hours, the patient responded to the IV steroids and an improvement in mentation was noted. HE is a rare immune-mediated disorder, characterized by impaired brain function. The onset of which can be rapid or slowly developing over the course of many years but responds effectively to steroids. Turner syndrome is associated with a high incidence of autoimmune disorders, thus in the setting of a negative workup for more obvious causes, HE should be a consideration when encountered in a clinical scenario.
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Johnson ET, Eraly SG, Aandi Subramaniyam B, Muliyala KP, Moirangthem S, Reddi VSK, Jain S. Complexities of cooccurrence of catatonia and autoimmune thyroiditis in bipolar disorder: A case series and selective review. Brain Behav Immun Health 2022; 22:100440. [PMID: 36118271 PMCID: PMC9475125 DOI: 10.1016/j.bbih.2022.100440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/15/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022] Open
Abstract
In recent years the neurobiological underpinnings of catatonia have been an emerging area of interest. Catatonia is frequently encountered in mood disorders, neurological disorders and systemic illnesses. Furthermore, the manifestation of catatonia in autoimmune disorders such as NMDA receptor antibody encephalitis and thyroiditis reinforces its neuropsychiatric nature. Irrespective of cause benzodiazepines and electroconvulsive therapy remain the standard treatments for catatonia, although a proportion fail to respond to the same. This report describes three women with pre-existing bipolar disorder presenting in catatonia. Interestingly in all three, while benzodiazepines and electroconvulsive therapy failed, a dramatic resolution of catatonia with corticosteroids was noted following the detection of Hashimoto's thyroiditis. Hashimoto's encephalopathy presenting as catatonia has been reported, but our patients' profile differed in having had an a priory diagnosis of bipolar disorder. Given that both catatonia and thyroid dysfunction are frequently encountered in bipolar disorder, Hashimoto's encephalopathy as a potential cause for this concurrent manifestation in bipolar disorder may be overlooked. Therefore, it is essential to suspect Hashimoto's encephalopathy when catatonia manifests in bipolar disorder. A timely evaluation would be prudent as they may fail to respond to standard treatments for catatonia but respond remarkably to corticosteroids, saving much time and angst. Recent evidence implicates immune system dysfunction, with neuroinflammation and peripheral immune dysregulation contributing to the pathophysiology of bipolar disorder as well as catatonia. Findings from this study reaffirm the role of immune system dysfunction common to the etiopathogenesis of all these disorders, highlighting the complex interplay between catatonia, thyroiditis and bipolar disorder.
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Affiliation(s)
| | - Sara George Eraly
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | | | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | | | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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Abstract
Autoimmune encephalitis is a group of central nervous system (CNS) inflammatory disorders that most commonly affect young adults and children. These disorders are closely associated with antibodies against neuronal cell-surface proteins, receptors, and ion channels; however, some forms of the disorder have no known antibody at this time. In children, neurological manifestations such as seizure, movement disorders, and focal neurological deficits are more prominent at initial presentation than psychiatric or behavioral symptoms. When psychiatric symptoms do occur, they often manifest as temper tantrums, aggression, agitation, and rarely psychosis. Prompt diagnosis and early treatment can lead to improved outcomes and decreased relapses. First-line therapies include intravenous steroids, intravenous immunoglobulin, and plasmapheresis, whereas rituximab and cyclophosphamide are utilized for refractory or relapsing disease. This review highlights the different forms of this disorder, discusses approach to diagnosis and treatment, and reviews the outcome and prognosis of children diagnosed with different forms of autoimmune encephalitis.
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14
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Relationship between thyroid hormones and central nervous system metabolism in physiological and pathological conditions. Pharmacol Rep 2022; 74:847-858. [PMID: 35771431 DOI: 10.1007/s43440-022-00377-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/08/2022]
Abstract
Thyroid hormones (THs) play an important role in the regulation of energy metabolism. They also take part in processes associated with the central nervous system (CNS), including survival and differentiation of neurons and energy expenditure. It has been reported that a correlation exists between the functioning of the thyroid gland and the symptoms of CNS such as cognitive impairment, depression, and dementia. Literature data also indicate the influence of THs on the pathogenesis of CNS diseases, such as Alzheimer's disease, epilepsy, depression, and Parkinson's disease. This review describes the relationship between THs and metabolism in the CNS, the effect of THs on the pathological conditions of the CNS, and novel options for treating these conditions with TH derivatives.
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15
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Song X, Ma J, Li X, Jiang L. Children suspected of having intracranial infection with normal brain magnetic resonance imaging may be associated with the myelin oligodendrocyte glycoprotein antibody. Brain Dev 2022; 44:281-286. [PMID: 35042648 DOI: 10.1016/j.braindev.2021.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/01/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To confirm whether encephalitis due to unknown causes but with normal brain magnetic resonance imaging (MRI) may be associated with the myelin oligodendrocyte glycoprotein (MOG) antibody. METHODS We retrospectively analyzed and summarized the characteristics of three patients initially suspected of having intracranial infections with normal brain MRI, and ultimately tested positive for anti-MOG antibody. RESULTS The three patients mainly presented with long-term fever accompanied by headaches and drowsiness. Auxiliary examinations showed obvious leukocytosis in peripheral blood and leukocytosis and increased protein expression in cerebrospinal fluid (CSF); furthermore, brain MRI was normal. These findings suggested intracranial infection, especially bacterial meningitis. No patient showed a response to prolonged anti-bacterial therapy; however, they recovered with glucocorticoid therapy, which was prescribed after anti-MOG antibodies were detected in the serum and CSF samples. CONCLUSION Anti-MOG antibody detection should be performed early for patients with suspected encephalitis due to unknown causes with normal brain MRI, to identify whether they have MOG antibody-associated diseases (MOGAD).
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Affiliation(s)
- Xiaojie Song
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jiannan Ma
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China.
| | - Xiujuan Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Shadmani G, Simkins TJ, Assadsangabi R, Apperson M, Hacein-Bey L, Raslan O, Ivanovic V. Autoimmune diseases of the brain, imaging and clinical review. Neuroradiol J 2022; 35:152-169. [PMID: 34490814 PMCID: PMC9130615 DOI: 10.1177/19714009211042879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is an extensive spectrum of autoimmune entities that can involve the central nervous system, which has expanded with the emergence of new imaging modalities and several clinicopathologic entities. Clinical presentation is usually non-specific, and imaging has a critical role in the workup of these diseases. Immune-mediated diseases of the brain are not common in daily practice for radiologists and, except for a few of them such as multiple sclerosis, there is a vague understanding about differentiating them from each other based on the radiological findings. In this review, we aim to provide a practical diagnostic approach based on the unique radiological findings for each disease. We hope our diagnostic approach will help radiologists expand their basic understanding of the discussed disease entities and narrow the differential diagnosis in specific clinical scenarios. An understanding of unique imaging features of these disorders, along with laboratory evaluation, may enable clinicians to decrease the need for tissue biopsy.
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Affiliation(s)
- Ghazal Shadmani
- Department of Radiology, Section of
Neuroradiology, University of California Davis Medical Center, USA
| | - Tyrell J Simkins
- Department of Neurology
(Neuroimmunulogy), University of California Davis Medical center, USA
| | - Reza Assadsangabi
- Department of Radiology, Section of
Neuroradiology, University of California Davis Medical Center, USA
| | - Michelle Apperson
- Department of Neurology
(Neuroimmunulogy), University of California Davis Medical center, USA
| | - Lotfi Hacein-Bey
- Department of Radiology, Section of
Neuroradiology, University of California Davis Medical Center, USA
| | - Osama Raslan
- Department of Radiology, Section of
Neuroradiology, University of California Davis Medical Center, USA
| | - Vladimir Ivanovic
- Department of Radiology, Section of
Neuroradiology, University of California Davis Medical Center, USA
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17
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Silva T, Ferreira S, Esteves P, Cerejeira J. Steroid-responsive encephalopathy associated with autoimmune thyroiditis presenting with a postpartum psychosis. BMJ Case Rep 2022; 15:e246199. [PMID: 35288425 PMCID: PMC8921851 DOI: 10.1136/bcr-2021-246199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/04/2022] Open
Abstract
Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is a rare condition characterised by neuropsychiatric symptoms, presence of antithyroid antibodies and significant response to steroid therapy. Postpartum psychosis (PP), although having a low prevalence, is a psychiatrical emergency with potentially serious impact in the mother and children. PP has an atypical presentation when compared with affective or psychotic episodes unrelated to pregnancy. Autoimmune dysfunction is frequent in the postpartum period and is closely related to PP. We report a case of a primiparous woman in her 20s with PP who did not respond to initial treatment with antipsychotics. After reassessment, SREAT was considered in the differential diagnosis. Neuropsychiatric symptoms improved dramatically after 72 hours of treatment with high-dose steroids treatment and the patient was discharged after 16 days. In women with PP, an autoimmune cause must be ruled out before assuming a psychiatry aetiology.
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Affiliation(s)
- Tânia Silva
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Sofia Ferreira
- Psychiatry, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Pedro Esteves
- Psychiatry, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
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18
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Li C, Tang GC, Chen GX. Hashimoto's encephalopathy with interesting neuroimaging performance: a case report. Acta Neurol Belg 2022:10.1007/s13760-022-01880-w. [PMID: 35147869 DOI: 10.1007/s13760-022-01880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Cao Li
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Guang-Cai Tang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guang-Xiang Chen
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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19
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Aladdin Y, Shirah B. Hashimoto's Encephalopathy Masquerading as Rapidly Progressive Dementia and Extrapyramidal Failure. J Neurosci Rural Pract 2022; 13:101-104. [PMID: 35110927 PMCID: PMC8803526 DOI: 10.1055/s-0041-1741487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hashimoto's encephalopathy is a rare immune-mediated disorder characterized by subacute encephalopathy with elevated thyroid antibodies. Hashimoto's encephalopathy is also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis. We report a rare presentation of Hashimoto's encephalopathy presenting with acute neuropsychiatric disturbances, rapidly progressive dementia, seizures, and extrapyramidal failure. Neuroimaging revealed multifocal vasculitides of major cerebral vessels that support the autoimmune vasculitic theory as the underlying pathogenesis for Hashimoto's encephalopathy. Unfortunately, permanent irreversible cerebral damage has already ensued before her presentation to our center, which rendered steroid therapy ineffective. Serological testing for Hashimoto's thyroiditis must be in the investigation of all rapidly progressive dementias as early diagnosis and timely management of autoimmune thyroiditis may salvage sizable and eloquent cerebral tissues. The rarity of the condition should not preclude the investigation of Hashimoto's disease even in the presence of normal levels of thyroid hormones. Delayed diagnosis may result in irreversibly catastrophic encephalopathy in patients who once presented with potentially curable dementia.
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Affiliation(s)
- Yasser Aladdin
- King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Bader Shirah
- Department of Neuroscience, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
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20
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Vieira IH, Rodrigues D, Paiva I. The Mysterious Universe of the TSH Receptor. Front Endocrinol (Lausanne) 2022; 13:944715. [PMID: 35903283 PMCID: PMC9315062 DOI: 10.3389/fendo.2022.944715] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/10/2022] [Indexed: 12/25/2022] Open
Abstract
The thyroid-stimulating hormone receptor (TSH-R) is predominantly expressed in the basolateral membrane of thyrocytes, where it stimulates almost every aspect of their metabolism. Several extrathyroidal locations of the receptor have been found including: the pituitary, the hypothalamus, and other areas of the central nervous system; the periorbital tissue; the skin; the kidney; the adrenal; the liver; the immune system cells; blood cells and vascular tissues; the adipose tissue; the cardiac and skeletal muscles, and the bone. Although the functionality of the receptor has been demonstrated in most of these tissues, its physiological importance is still a matter of debate. A contribution to several pathological processes is evident in some cases, as is the case of Grave's disease in its multiple presentations. Conversely, in the context of other thyroid abnormalities, the contribution of the TSH-R and its ligand is still a matter of debate. This article reviews the several different sites of expression of the TSH-R and its potential role in both physiological and pathological processes.
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21
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Bidaki R, Saghafi F, Ahrari S, Aghamollaii V, Rahmani M, Asadi A. Challenges in corticosteroid dose regulation in a patient with autoimmune thyroid disease and neuropsychiatric syndrome: A running commentary. Clin Case Rep 2021; 9:e05081. [PMID: 34963799 PMCID: PMC8710709 DOI: 10.1002/ccr3.5081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/24/2021] [Accepted: 10/31/2021] [Indexed: 11/24/2022] Open
Abstract
In the following, we report a therapeutic challenge faced by reduction in corticosteroid therapeutic dosage in a patient diagnosed with Hashimoto's encephalopathy (HE), which is equivalent to corticosteroid-responsive encephalopathy related to autoimmune thyroiditis and often misdiagnosed as neuropsychiatric status. The patient developed psychiatric symptoms.
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Affiliation(s)
- Reza Bidaki
- Research Center of Addiction and Behavioral SciencesShahid Sadoughi University of Medical SciencesYazdIran
- Diabetes Research CenterShahid Sadoughi University of Medical SciencesYazdIran
| | - Fatemeh Saghafi
- Department of Clinical PharmacyFaculty of Pharmacy and Pharmaceutical Sciences Research CenterShahid Sadoughi University of Medical SciencesYazdIran
| | - Samira Ahrari
- Department of Psychiatry and Behavioral SciencesCollege of MedicineTexas A&M UniversityBrownsvilleTexasUSA
| | | | - Mojde Rahmani
- Faculty of PharmacyShahid Sadoughi University of Medical SciencesYazdIran
| | - Ahdie Asadi
- Faculty of PharmacyShahid Sadoughi University of Medical SciencesYazdIran
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22
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Taylor K, Muscal E, Van Mater H. The Role of Pediatric Rheumatologists in Autoimmune Brain Disease. Rheum Dis Clin North Am 2021; 48:343-369. [PMID: 34798957 DOI: 10.1016/j.rdc.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The spectrum of autoimmune and inflammatory brain diseases continues to evolve with medical advances facilitating both the detection of inflammation of the central nervous system and the discovery of novel disease mechanisms. The clinical overlap of these disorders with primary rheumatic diseases and the efficacy of immunotherapy have led to strong partnerships between pediatric rheumatologists, neurologists, psychiatrists, and other providers in the care of children with these conditions. Early diagnosis and initiation of targeted therapy improve clinical outcomes, highlighting the importance of interdisciplinary collaborative care.
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Affiliation(s)
- Kathryn Taylor
- Pediatrics, Division of Neurology, Duke University, Durham, NC, USA.
| | - Eyal Muscal
- Division of Rheumatology and Co-appointment in Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Heather Van Mater
- Pediatrics, Division of Rheumatology, Duke University, Durham, NC, USA
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23
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Shimada T, Nakajima S, Nakamura R, Kurita N, Ogaki K, Watanabe M, Yamashiro K, Urabe T. Hashimoto's encephalopathy with gait disturbance caused by sensory ganglionopathy: A case report and review of the literature. eNeurologicalSci 2021; 25:100370. [PMID: 34660918 PMCID: PMC8502713 DOI: 10.1016/j.ensci.2021.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/21/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022] Open
Abstract
Hashimoto's encephalopathy (HE) is a steroid-responsive encephalopathy characterized by several neurological symptoms. HE mainly involves the central nervous system; the peripheral nervous system is rarely involved. We treated a previously healthy elderly man showing mild cognitive decline and subacute progressive gait disturbance due to severe sensory deficits, including sensation of touch and deep sensation with elevated anti-NH2 terminal of α-enolase and anti-thyroid antibodies. His sensory disturbance symptoms improved after steroid therapy, suggesting that the neuropathy was related to HE. His disease was characteristic of HE in that his sensory deficits responded well and rapidly to steroid therapy. A nerve conduction study showed reduced sensory nerve action potentials in all limbs, indicating that his neuropathy was not “axonopathy”, but “sensory ganglionopathy”, which can occur concurrently with autoimmune disorders. Dysautonomia may be the responsible pathomechanism because of the vulnerability of the blood–nerve barrier at the ganglia. Although the pathophysiology of HE has not been clearly elucidated, autoimmune inflammation has been reported in a number of autopsy cases, indicating that sensory ganglionopathy can develop with HE. Therefore, HE should be recognized as one type of “treatable neuropathy”.
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Affiliation(s)
- Tomoyo Shimada
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan.,Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Sho Nakajima
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Ryota Nakamura
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Naohide Kurita
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kotaro Ogaki
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Masao Watanabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kazuo Yamashiro
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
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24
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John R, Datta A, Ovallath S. A Case of Euthyroid Steroid-Responsive Encephalopathy With Subacute Dementia. Cureus 2021; 13:e17689. [PMID: 34513537 PMCID: PMC8415802 DOI: 10.7759/cureus.17689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/29/2022] Open
Abstract
Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), frequently termed as Hashimoto's encephalopathy (HE), is characterized by reversible encephalopathy with the presence of elevated antithyroid antibodies. The condition was initially described due to its association with Hashimoto's thyroiditis. We report a case of euthyroid HE presenting as subacute dementia. A 50-year-old woman presented with progressive memory decline for six weeks. Thyroid function tests, thyroid ultrasound, and cerebrospinal fluid analysis were unremarkable. Electroencephalogram showed generalized slowing with triphasic waves. On magnetic resonance imaging, T1 weighted images revealed hyperintensity in bilateral basal ganglia. Antithyroglobulin and antithyroid peroxidase were markedly elevated. She improved remarkably on tablet prednisolone 60 mg once daily, confirming the suspicion of steroid-responsive encephalopathy. Thus, we conclude that patients with subacute cognitive decline could be screened for antithyroid antibodies in the dementia workup despite their euthyroid status.
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Affiliation(s)
- Rebecca John
- Department of Neurology, Kannur Medical College, Anjarakandy, Kannur, IND
| | - Abhigyan Datta
- Department of Medicine, Maulana Azad Medical College, New Delhi, IND
| | - Sujith Ovallath
- Department of Neurology, Kannur Medical College, Anjarakandy, Kannur, IND
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25
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Yıldırım M, Bektaş Ö, Botan E, Şahin S, Gurbanov A, Teber S, Kendirli T. Therapeutic plasma exchange in clinical pediatric neurology practice: Experience from a tertiary referral hospital. Clin Neurol Neurosurg 2021; 207:106823. [PMID: 34304066 DOI: 10.1016/j.clineuro.2021.106823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aims to retrospectively evaluate the long-term efficacy, tolerability, and safety of therapeutic plasma exchange (TPE) in children with various neuroimmunological disorders. METHODS This analysis was a single-center, retrospective cohort study of pediatric patients with neuroimmunological events undergoing TPE procedures in a tertiary referral center. RESULTS There were 23 patients, 14 boys (60.9%), aged at diagnosis onset 8 months to 16.8 years. The main indications of TPE were Guillain-Barré syndrome (GBS, n = 8), autoimmune encephalitis (n = 5), febrile infection-related epilepsy syndrome (FIRES, n = 4), and acute disseminated encephalomyelitis (ADEM, n = 3). There was no life-threatening complication due to the TPE procedures. Eight (34.8%) of 23 patients experienced 13 (7%) complications in 186 TPE procedures, mostly electrolyte disturbances (n = 5). None of patients discontinued TPE due to complications. Two (8.7%) of 23 patients had marked improvement, 6 (26.1%) had moderate and 11 (47.8%) had mild improvement after TPE. The last follow-up visit revealed neurological sequelae in 12 (52.2%) patients. Therapeutic plasma exchange was found to be more effective on GBS, autoimmune encephalitis and myasthenia gravis, less effective on ADEM and FIRES. There was no correlation between improvement with TPE and clinical parameters, including age, sex, diagnosis, disease duration before TPE, presence of intubation, and length of stay in the intensive care unit and hospital. CONCLUSION Therapeutic plasma exchange was found to be effective and well-tolerated in children with various types of neuroimmunological disorder, with at least mild improvement in approximately 80% of the patients and no life-threatening complications.
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Affiliation(s)
- Miraç Yıldırım
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Ömer Bektaş
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Edin Botan
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Süleyman Şahin
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Anar Gurbanov
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey.
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26
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Jegatheeswaran V, Chan M, Chen YA. MRI Findings of Two Patients With Hashimoto Encephalopathy. Cureus 2021; 13:e15697. [PMID: 34277284 PMCID: PMC8285190 DOI: 10.7759/cureus.15697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Hashimoto encephalopathy (HE), also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), is a rare type of autoimmune encephalitis that typically presents with cognitive and neuropsychiatric symptoms that resolve with steroids. Positive neuroimaging findings of HE are rarely reported in the literature. We present two cases of HE with abnormal MRI findings, including signal abnormalities in the claustrum, cerebral white matter, and mesial temporal lobes. HE and other forms of autoimmune encephalopathies can often be misdiagnosed as viral encephalopathies. As such detection of subtle neuroimaging findings in the context of suspicious clinical history should prompt further investigations to ensure accurate and timely diagnosis.
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Affiliation(s)
| | - Michael Chan
- Department of Medical Imaging, University of Toronto, Toronto, CAN.,Department of Diagnostic Imaging, Trillium Health Partners, Mississauga, CAN
| | - Yingming A Chen
- Department of Medical Imaging, University of Toronto, Toronto, CAN.,Department of Diagnostic Imaging, Trillium Health Partners, Mississauga, CAN
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27
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Vermeersch G, Maes J. Encephalopathy associated with autoimmune thyroid disease: a rare but frequently missed neuropsychiatric syndrome. Acta Neurol Belg 2021; 121:821-822. [PMID: 33866534 PMCID: PMC8053231 DOI: 10.1007/s13760-021-01682-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/13/2021] [Indexed: 11/19/2022]
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28
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Zala N, Wirth L, Jordan B, Meredig H, Rizos T. Thunderclap Headache: A Primary Symptom of a Steroid-Responsive Encephalopathy with Autoimmune Thyroiditis. Case Rep Neurol Med 2021; 2021:5517934. [PMID: 34055433 PMCID: PMC8137291 DOI: 10.1155/2021/5517934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022] Open
Abstract
Thunderclap headache is frequently associated with serious intracranial vascular disorders and a usual reason for emergency department admissions. Association of thunderclap headaches with autoimmune disorders, such as steroid-responsive encephalopathy with autoimmune thyroiditis (SREAT), is highly unusual. Here, we report a patient who presented with high-intensity headache of abrupt onset. Cerebrospinal fluid (CSF) analysis revealed moderate lymphocytic pleocytosis without evidence of infectious, neoplastic, or metabolic causes. Brain magnetic resonance imaging showed no specific pathologies, and examinations for neuronal antibodies in serum and CSF were negative. The medical history revealed that seven years before, an episode of an aseptic meningoencephalitis with remarkable response to steroids was present. Finally, increased levels of serum anti-TPO antibodies were identified, and against the background of a previous steroid-responsive aseptic meningoencephalitis, diagnosis of SREAT was highly probable. Methylprednisolone therapy was initiated, and the patient recovered completely. In particular, because most SREAT patients respond very well to steroids, this case underlines the importance of taking SREAT into consideration during the assessment of a high-intensity headache of abrupt onset.
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Affiliation(s)
- Naman Zala
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Lena Wirth
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Berit Jordan
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Hagen Meredig
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Timolaos Rizos
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
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29
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Anti-N-methyl-d-aspartate receptor encephalitis associated with intracranial cryptococcal infection: A case report and 2-year follow-up. J Neuroimmunol 2021; 353:577502. [PMID: 33548619 DOI: 10.1016/j.jneuroim.2021.577502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 11/20/2022]
Abstract
Anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis is a type of autoimmune encephalitis characterized by the rapid onset of neurologic dysfunction. Several studies have reported the important role of post-infectious effect in its pathogenesis. Herein, we report on a 68-year-old woman diagnosed with anti-NMDA receptor encephalitis with concomitant intracranial cryptococcal infection, who was followed up for two years and demonstrated clinical improvements after effective anti-fungal therapy. This case may help expand the clinical spectrum of post-infectious immune-mediated etiology of anti-NMDA receptor encephalitis. The pathogenic role of both disorders requires further investigation.
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30
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Bevins EA, Peters J, Léger GC. The Diagnosis and Management of Reversible Dementia Syndromes. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-020-00657-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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31
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Mohammadi S, Dolatshahi M, Rahmani F. Shedding light on thyroid hormone disorders and Parkinson disease pathology: mechanisms and risk factors. J Endocrinol Invest 2021; 44:1-13. [PMID: 32500445 DOI: 10.1007/s40618-020-01314-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by loss of dopaminergic neurons. Dopaminergic system is interconnected with the hypothalamic-pituitary-thyroid axis. Dopamine (DA) upregulates thyrotropin releasing hormone (TRH) while downregulating thyroid stimulating hormone (TSH) and thyroid hormones. Moreover, TRH stimulates DA release. PD is associated with impaired regulation of TSH and thyroid hormones (TH) levels, which in turn associate with severity and different subtypes of PD, while levodopa and bromocriptine treatment can interfere with hypothalamic-pituitary-thyroid axis. Thyroid disturbances, including hypothyroidism, Hashimoto's thyroiditis (HT), hyperthyroidism and Graves' disease (GD) not only increase the risk of PD but also share some clinical signs with PD. Also, several genes including RASD2, WSB1, MAPT, GIRK2, LRRK2 and gene products like neurotensin and NOX/DUOX affect the risk for both PD and thyroid disease. Hypothyroidism is associated with obesity, hypercholesterolemia, anemia and altered cerebral blood flow which are associated with PD pathology. Herein we provide a comprehensive view on the association between PD and thyroid hormones regulation and dysregulations, hoping to provide new avenues towards targeted treatment of PD. We performed a comprehensive search in literature using Pubmed and Scopus, yielding to a total number of 36 original articles that had addressed the association between thyroid hormone disorders and PD.
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Affiliation(s)
- S Mohammadi
- Student's Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - M Dolatshahi
- Student's Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - F Rahmani
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
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32
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Paredes-Aragón EM, Valdéz-Ruvalcaba HE, Santos-Peyret A, Cisneros-Otero M, Medina-Rioja R, Orozco-Suárez S, Hernandez MM, Breda-Yepes MDL, Rivas-Alonso V, Flores-Rivera JJ, Martínez-Juárez IE. Continuous Visual Focal Status Epilepticus as the Primary Presentation of NMDA-R and GAD65-R Autoimmune Epilepsy. Front Neurol 2020; 11:598974. [PMID: 33324338 PMCID: PMC7726346 DOI: 10.3389/fneur.2020.598974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/21/2020] [Indexed: 11/15/2022] Open
Abstract
Epilepsia partialis continua (EPC) has changed in its clinical and pathophysiological definition throughout time. Several etiologies have been described in addition to classic causes of EPC. The following case depicts a young woman who had a peculiar onset of epilepsy with a continuous visual aura becoming a form of chronic recurrent and non-progressive EPC. The patient was initially misdiagnosed as a non-neurological entity (assumed psychiatric in origin), but finally, an immune-mediated epilepsy was diagnosed, and EEG showed focal status epilepticus during evolution. Once the diagnosis was achieved and immune treatment was established, the patient is seizure free. Early identification of an immune basis in patients with epilepsy is important because immunotherapy can reverse the epileptogenic process and reduce the risk of chronic epilepsy. To date, this is the only case reported with EPC manifesting as a continuous visual aura associated with antiglutamic acid decarboxylase 65 (anti-GAD65) and anti-N-methyl-d-aspartate (anti-NMDA) antibodies.
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Affiliation(s)
| | | | - Andrea Santos-Peyret
- Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Marcela Cisneros-Otero
- Neuropsychiatry Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Raúl Medina-Rioja
- Neurology Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Sandra Orozco-Suárez
- Unit of Medical Research in Neurologic Diseases (UIMEN), Medical National Center Century XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Miriam M. Hernandez
- Neurology Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Verónica Rivas-Alonso
- Neuroimmunology Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - José J. Flores-Rivera
- Neuroimmunology Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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33
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Gultekin MA, Cesme DH, Karaman O, Yurtsever I, Tasan E, Yilmaz TF, Alkan A. Brain Diffusion Tensor Imaging Findings in Hashimoto's Thyroiditis. J Neuroimaging 2020; 31:215-221. [PMID: 33156574 DOI: 10.1111/jon.12804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Hashimoto's thyroiditis (HT) is a type of autoimmune thyroid disease. Diffusion tensor imaging (DTI) can evaluate microstructural brain involvement in various diseases. We aimed to investigate whether there were any DTI differences in patients with HT, and the relationship between DTI values and disease duration time and thyroid peroxidase antibodies (TPOAb) levels. METHODS We prospectively included 36 patients with HT (mean age 41.6 ± 13.8 years, range 18-64 years) and 18 age and sex-matched healthy control subjects (mean age 41.6 ± 13.1 years, range 18-63 years). All patients were euthyroid at the time of imaging. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) values of 15 distinct neuroanatomical locations were measured and compared. RESULTS FA values of the patients with HT were lower in cingulum, globus pallidus (GP), cerebellar white matter (CWM) than the control (P = .019, .002, and <.001, respectively). MD values of the CWM in patients were higher than the control (P = .008). AD values of patients with HT were lower in the cingulum, posterior limbs of the internal capsule, GP, and putamen (P = .038, .038, .030, and .045, respectively). RD values of cingulum and CWM in HT were higher than controls (P <.001 and P = .011, respectively). There was a negative relationship between the FA values of PLIC and a positive relationship between the MD values of the corona radiata and TPOAb levels were detected. CONCLUSIONS The current DTI study presented microstructural changes in the neurocognitive-related areas that may be related to accompanying neurological findings in HT.
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Affiliation(s)
- Mehmet Ali Gultekin
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Dilek Hacer Cesme
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozcan Karaman
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ismail Yurtsever
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ertugrul Tasan
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Temel Fatih Yilmaz
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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34
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Phinney TA, Kinem DJ, Mayoglou LC, Laghari FJ. AntiGAD65 antibodies encephalitis with lateralized periodic discharges: A case report. J Neuroimmunol 2020; 347:577354. [DOI: 10.1016/j.jneuroim.2020.577354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022]
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35
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Amamou B, Ben Saida I, Ben Haouala A, Mhalla A, Zaafrane F, Gaha L. Hashimoto’s Encephalopathy Revealed by Hypochondriacal Delusion: A Case Report Involving a Male Patient. Am J Mens Health 2020; 14:1557988320955080. [PMID: 32938289 PMCID: PMC7503015 DOI: 10.1177/1557988320955080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hashimoto’s encephalopathy (HE) is a rare autoimmune disorder. It associates encephalopathy with autoimmune thyroiditis, presenting abnormal elevations of thyroid antibodies. It is more common in females. It can present with various symptoms, including seizures, myoclonus, psychosis, hallucinations, and mood disturbances. Hypochondriacal delusion is an unusual clinical presentation of this disorder. The authors report a case of HE in a male patient whose clinical presentation was dominated by hypochondriacal delusion. The absence of response to antipsychotics, high serum antithyroid peroxidase antibodiesof about 199 UI/ml, the normality of magnetic resonance imaging, and improvement with corticosteroids confirmed the diagnosis. This neuroendocrine disorder is often misdiagnosed and it represents a diagnostic challenge for clinicians. It should be considered in patients presenting a refractory or an atypical neuropsychiatric disorder and having a family history of autoimmune disease.
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Affiliation(s)
- Badii Amamou
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Faculty of Medecine of Monastir, University of Monastir, Monastir, Tunisia
| | - Imen Ben Saida
- Medical Intensive Care Unit, Farhat Hached University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Amjed Ben Haouala
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Faculty of Medecine of Monastir, University of Monastir, Monastir, Tunisia
| | - Ahmed Mhalla
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Faculty of Medecine of Monastir, University of Monastir, Monastir, Tunisia
| | - Ferid Zaafrane
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Faculty of Medecine of Monastir, University of Monastir, Monastir, Tunisia
| | - Lotfi Gaha
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Faculty of Medecine of Monastir, University of Monastir, Monastir, Tunisia
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36
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Ellul P, Gasnier M, Trebossen V, Gaillard R. Immune Activation and Deficit in Neurotransmitters Synthesis in Treatment Resistant Depression: About a Case of Hashimoto Encephalopathy. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2020; 18:463-466. [PMID: 32702227 PMCID: PMC7383012 DOI: 10.9758/cpn.2020.18.3.463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/05/2019] [Accepted: 06/10/2019] [Indexed: 12/31/2022]
Abstract
We report a case of Hashimoto encephalopathy initially presented as a drug-resistant depression with predominant apathy and asthenia, successfully treated with cyclophosphamide. We suspected that the psychiatric symptoms were due to a deficit in neurotransmitter synthesis related to immune activation. We hypothesized that the immunomodulatory treatment helped to restore the neurotransmitter synthesis and thus decreased the patient’s depressive symptoms. In this case report we propose an innovative model in which immunity might disturbs neurotransmitters synthesis leading to depressive symptoms.
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Affiliation(s)
- Pierre Ellul
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert Debré Hospital, Department of Child and Adolescent Psychiatry, Paris, France
| | - Matthieu Gasnier
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hotel-Dieu, Unité de Psychiatrie, Paris, France
| | - Vincent Trebossen
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert Debré Hospital, Department of Child and Adolescent Psychiatry, Paris, France
| | - Raphael Gaillard
- Centre Hospitalier Sainte-Anne, Faculty of Medicine Paris Descartes, Service Hospitalo-Universitaire, Paris, France.,Université Paris Descartes, INSERM UMR S894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Paris, France
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37
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Delgado-García G, Balint B. Hashimoto's Encephalopathy: Back to Square One. Mov Disord Clin Pract 2020; 7:627-628. [PMID: 32775507 DOI: 10.1002/mdc3.13012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Guillermo Delgado-García
- Laboratorio Clínico de Enfermedades Neurodegenerativas Instituto Nacional de Neurología y Neurocirugía Mexico City Mexico.,Programa de Maestría y Doctorado en Ciencias Médicas Odontológicas y de la Salud (PMDCMOS), Universidad Nacional Autónoma de México Mexico City Mexico
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London UK.,Department of Neurology University Hospital Heidelberg Heidelberg Germany
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38
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Anti-Thyroid Peroxidase/Anti-Thyroglobulin Antibody-Related Neurologic Disorder Responsive to Steroids Presenting with Pure Acute Onset Chorea. Tremor Other Hyperkinet Mov (N Y) 2020; 10:19. [PMID: 32775033 PMCID: PMC7394228 DOI: 10.5334/tohm.175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Pure acute onset chorea without encephalopathy has rarely been reported in anti-thyroid peroxidase (anti-TPO)/anti-thyroglobulin (anti-TG) antibody-related neurologic disorders responsive to steroids (ATANDS). Case report: We report a 16-year-old female who presented with acute chorea without encephalopathy. Anti-TPO antibodies were found to be strongly positive (>1200 IU/ml) along with anti-thyroglobulin and anti-thyroid stimulating hormone receptor antibodies. After pulse intravenous methylprednisolone therapy (1 g/day for five consecutive days), all the movements seized, and she was discharged with oral prednisolone 30 mg/day with gradual tapering over next three months. After one year of follow-up, she is stable, drug-free, and never had any other problems. Discussion: Anti-thyroid antibodies testing should be included in routine/conventional panel that is done for elucidating causes of chorea as ATANDS can be easily missed and is treatable with widely available, relatively low-cost drugs like steroids with a promising outcome.
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Adams AV, Mooneyham GC, Van Mater H, Gallentine W. Evaluation of Diagnostic Criteria for Hashimoto Encephalopathy Among Children and Adolescents. Pediatr Neurol 2020; 107:41-47. [PMID: 32173161 DOI: 10.1016/j.pediatrneurol.2019.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/08/2019] [Accepted: 12/18/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The recently proposed adult diagnostic criteria for the Hashimoto encephalopathy (HE) include a requirement of subclinical or mild thyroid disease. However, most reports indicate that most children treated for HE do not have evidence of thyroid disease. We aim to evaluate the impact of applying the current adult diagnostic criteria to pediatric patients. METHODS Pediatric patients with HE were evaluated at time of symptom onset and follow-up at least 1 year after initiation of immunomodulatory treatment for degree of impairment within the neuropsychiatric domains of cognition, language, psychiatric disturbance, seizure, movement disorder, sleep disruption, and overall functionality. We compared the response to treatment among patients stratified by the presence or absence of subclinical or mild thyroid disease using the Modified Rankin Scale, the Liverpool Outcome Score, and a novel multidomain scale designed for the population with pediatric autoimmune brain disorders. RESULTS Of 17 pediatric patients treated for HE, 6 met full adult diagnostic criteria, whereas 11 patients did not meet criteria solely owing to the absence of thyroid disease. Using our novel scale, the 6 patients meeting full criteria had statistically significant improvement from time of onset of disease to follow-up in the domain of cognition. The 11 patients who did not meet full criteria based on their absence of thyroid disease exhibited statistically significant improvement from time of onset of disease to follow-up in the domains of cognition, language, psychiatric disturbance, movement, and sleep. CONCLUSIONS Rigidly applying the current diagnostic criteria to pediatric patients with suspected HE may result in the failure to treat potential responders. We propose a set of diagnostic criteria for HE in children, which does not require thyroid disease but include abrupt onset cognitive regression with deficits in one or more other neuropsychiatric domains in the setting of antithyroid antibodies.
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Affiliation(s)
- Ashley V Adams
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - GenaLynne C Mooneyham
- Department of Pediatrics, Duke University, Durham, North Carolina; Department of Psychiatry, Duke University, Durham, North Carolina
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40
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Pedroso JL, Vale TC, Braga-Neto P, Dutra LA, França MC, Teive HAG, Barsottini OGP. Acute cerebellar ataxia: differential diagnosis and clinical approach. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 77:184-193. [PMID: 30970132 DOI: 10.1590/0004-282x20190020] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/02/2018] [Indexed: 12/20/2022]
Abstract
Cerebellar ataxia is a common finding in neurological practice and has a wide variety of causes, ranging from the chronic and slowly-progressive cerebellar degenerations to the acute cerebellar lesions due to infarction, edema and hemorrhage, configuring a true neurological emergency. Acute cerebellar ataxia is a syndrome that occurs in less than 72 hours, in previously healthy subjects. Acute ataxia usually results in hospitalization and extensive laboratory investigation. Clinicians are often faced with decisions on the extent and timing of the initial screening tests, particularly to detect treatable causes. The main group of diseases that may cause acute ataxias discussed in this article are: stroke, infectious, toxic, immune-mediated, paraneoplastic, vitamin deficiency, structural lesions and metabolic diseases. This review focuses on the etiologic and diagnostic considerations for acute ataxia.
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Affiliation(s)
- José Luiz Pedroso
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Unidade de Neurologia Geral e de Ataxias, São Paulo SP, Brasil
| | - Thiago Cardoso Vale
- Universidade Federal de Juiz de Fora, Departamento de Clínica Médica, Serviço de Neurologia do Hospital Universitário, Juiz de Fora MG, Brasil
| | - Pedro Braga-Neto
- Universidade Federal do Ceará, Departamento de Medicina Clínica, Divisão de Neurologia, Fortaleza CE, Brasil.,Universidade Estadual do Ceará, Centro de Ciências da Saúde, Fortaleza CE, Brasil
| | - Lívia Almeida Dutra
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Unidade de Neurologia Geral e de Ataxias, São Paulo SP, Brasil.,Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo SP, Brasil
| | | | - Hélio A G Teive
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Setor de Distúrbios do Movimento, Curitiba PR, Brasil
| | - Orlando G P Barsottini
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Unidade de Neurologia Geral e de Ataxias, São Paulo SP, Brasil
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41
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Kumar N, Shree R, Madhaw G, Manchanda R, Radhakrishnan D. Steroid responsive catatonia: A case of Hashimoto’s encephalopathy. ANNALS OF MOVEMENT DISORDERS 2020. [DOI: 10.4103/aomd.aomd_32_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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42
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Vicent MG, Cantarín V, Guerrero C, Molina B, Nieto M, López P, Iglesias MI, Díaz MA. Hashimoto encephalopathy as manifestation of central nervous system chronic graft-versus-host disease after hematopoietic stem cell transplantation. Pediatr Blood Cancer 2019; 66:e28008. [PMID: 31535441 DOI: 10.1002/pbc.28008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Carmen Guerrero
- Brain Bank Section, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Blanca Molina
- Stem Cell Transplant Unit, Hospital Niño Jesús, Madrid, Spain
| | | | - Pilar López
- Neurophysiology Section, Hospital Niño Jesús, Madrid, Spain
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43
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Liu S, Ma Q, Zheng Y. Febrile Hashimoto's encephalopathy associated with Graves' disease and acute pancytopenia: A case report. Medicine (Baltimore) 2019; 98:e18012. [PMID: 31852064 PMCID: PMC6922507 DOI: 10.1097/md.0000000000018012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Hashimoto's encephalopathy (HE) is an autoimmune-mediated encephalopathy rarely seen in Graves' disease, with <20 cases reported previously, associated with elevated concentration of circulating serum anti-thyroid antibodies usually responsive to steroid therapy. PATIENT CONCERNS We present a HE case (25-year-old male) with Graves' disease, complicated by fever and pancytopenia. The patient presented with fever, gait impairment, delirium, agitation and disorientation. DIAGNOSES Thyroid-related antibodies were elevated and brain magnetic resonance imaging confirmed symmetrical white-matter lesion. There was no evidence of infection or other reasons to explain all of his clinical manifestations. Hashimoto's encephalopathy (HE) is an autoimmune encephalopathy with various manifestations and the characteristic of elevated anti-thyroid antibodies and has no relationship to thyroid function. INTERVENTIONS The patient had nonspecific clinical manifestations and excellently respond to glucocorticoid therapy.The symptoms and the radiographic abnormalities disappeared after glucocorticoid therapy. OUTCOMES We followed up with him for 5 years, in which there was no recurrence and his thyroid function continued to be normal. LESSONS It is important to evaluate thyroid function and related antibodies in patients present with neuropsychological symptoms to avoid delay in diagnosis.
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44
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Hashimoto's encephalopathy in children: different manifestations of five cases. Acta Neurol Belg 2019; 119:595-599. [PMID: 31313264 DOI: 10.1007/s13760-019-01191-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
Hashimoto's encephalopathy (HE) is a rare, poorly understood, progressive and relapsing, steroid-responsive multiform disease. HE presents with subacute cognitive dysfunction, psychiatric symptoms, seizures, and movement disorders. The disorder is usually related to thyroid disease and the most frequent feature is the presence of anti-thyroperoxidase antibodies. Patients are generally euthyroid or mildly hypothyroid. The clinical features of two patients at presentation included refractory seizures and confusion, another patient had behavioral problems and altered cognitive status, one patient presented with right-sided weakness and numbness especially in his leg and tongue, dysphagia, speech disorder, aggressiveness, nightmares and nocturnal enuresis and last patient had focal seizures with altered mental status. All patients manifested increased anti-thyroid antibodies. Four patients improved with steroid treatment, and one of the patients responded to plasmapheresis instead of corticosteroid treatment. Physicians' awareness of this complication is of great importance because HE is a highly treatable condition among children and adolescents.
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45
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Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, Pham HP, Schneiderman J, Witt V, Wu Y, Zantek ND, Dunbar NM, Schwartz GEJ. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher 2019; 34:171-354. [PMID: 31180581 DOI: 10.1002/jca.21705] [Citation(s) in RCA: 782] [Impact Index Per Article: 156.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Eighth Edition of the JCA Special Issue continues to maintain this methodology and rigor in order to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Eighth Edition, like its predecessor, continues to apply the category and grading system definitions in fact sheets. The general layout and concept of a fact sheet that was introduced in the Fourth Edition, has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease entity or medical condition. The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.
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Affiliation(s)
- Anand Padmanabhan
- Medical Sciences Institute & Blood Research Institute, Versiti & Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance & University of Washington, Seattle, Washington
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Reinhard Klingel
- Apheresis Research Institute, Cologne, Germany & First Department of Internal Medicine, University of Mainz, Mainz, Germany
| | - Erin Meyer
- Department of Hematology/Oncology/BMT/Pathology, Nationwide Children's Hospital, Columbus, Ohio
| | - Huy P Pham
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jennifer Schneiderman
- Department of Pediatric Hematology/Oncology/Neuro-oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks NW & Department of Laboratory Medicine, University of Washington, Seattle, Washington, Yale University School of Medicine, New Haven, Connecticut
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Abstract
Cognitive impairment is a frequent presentation of patients who come to the hospital. We report a case of a patient who presents with a common symptom, however, with a rare disease. This is an 84-year-old woman with a history of hypertension and atrial fibrillation who was reported to have confusion of 3 weeks. Investigations, including a complete blood count, MRI imaging of the brain, cerebrospinal fluid analysis and paraneoplastic screen, were all negative. Of note, thyroid peroxidase antibody was elevated. She did not have a history of thyroid disease. Following this, an assessment of Hashimoto encephalopathy was made. She was started on steroids and she showed remarkable recovery within 2 months, therefore, confirming the diagnosis. This case report emphasises the need to consider Hashimoto's encephalopathy as a differential for delirium especially when other common aetiologies have been ruled out.
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Affiliation(s)
- Osakpolor Ogbebor
- Internal Medicine, Saint Peter’s University Hospital, New Brunswick, New Jersey, USA
| | - Kavya Patel
- Internal Medicine, Saint Peter’s University Hospital, New Brunswick, New Jersey, USA
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47
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Tjong E, Gardner R, Peng YY. SREAT presenting as decades of intractable seizures and isolated delusional episodes with clinical, laboratory, and EEG confirmation of treatment response. SAGE Open Med Case Rep 2019; 7:2050313X19850051. [PMID: 31205712 PMCID: PMC6537057 DOI: 10.1177/2050313x19850051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 04/16/2019] [Indexed: 11/15/2022] Open
Abstract
We report a case of a 60-year-old woman with a history of intractable seizures
and isolated delusional psychosis who was later diagnosed with
steroid-responsive encephalopathy associated with autoimmune thyroiditis. The
patient underwent right temporal lobectomy (epilepsy surgery) 15 years before
coming to this clinic, but continued to have focal seizures, resulting in
frequent emergency room visits thereafter. After admission for intensive
inpatient video electroencephalogram monitoring and subsequent 7 months of close
follow-up, both the electroencephalogram abnormalities and isolated delusional
psychosis were found to be responsive to immunotherapy. This suggests that her
epilepsy may be autoimmune in nature. Steroid-responsive encephalopathy
associated with autoimmune thyroiditis was diagnosed after 26 years since the
onset of seizures. Performing invasive epilepsy surgery in patients with
autoimmune epilepsy cannot reverse the inflammatory process; therefore, it is
reasonable to test for autoimmune etiologies before excision surgery on patients
with medically intractable epilepsy. This case demonstrates the clinical use of
quantitative electroencephalogram in assisting with the diagnosis of
steroid-responsive encephalopathy associated with autoimmune thyroiditis and
supports that it is a spectrum disorder with protean manifestations.
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Affiliation(s)
- Elysia Tjong
- A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ, USA
| | - Rachael Gardner
- Renown Institute for Neurosciences, Renown Health, Reno, NV, USA.,Department of Neurology, University of Nevada, Reno, Reno, NV, USA
| | - Yen-Yi Peng
- Renown Institute for Neurosciences, Renown Health, Reno, NV, USA.,Department of Neurology, University of Nevada, Reno, Reno, NV, USA
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48
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Nagano M, Kobayashi K, Yamada-Otani M, Kuzuya A, Matsumoto R, Oita J, Yoneda M, Ikeda A, Takahashi R. Hashimoto's Encephalopathy Presenting with Smoldering Limbic Encephalitis. Intern Med 2019; 58:1167-1172. [PMID: 30982805 PMCID: PMC6522399 DOI: 10.2169/internalmedicine.1289-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/08/2018] [Indexed: 01/18/2023] Open
Abstract
Hashimoto's encephalopathy (HE) is a steroid-responsive autoimmune encephalopathy associated with Hashimoto thyroiditis. We herein report a case of HE manifesting "smoldering" limbic encephalitis with persisting symptoms and abnormalities on examinations. Although our patient experienced partial clinical remission after treatment, hippocampal hypermetabolism on [18F] fluorodeoxyglucose positron emission tomography (FDG-PET) and subclinical seizures on video electroencephalography persisted. Hypermetabolism on FDG-PET was improved by additional prednisolone therapy. Thus, as with other autoimmune limbic encephalitis cases, HE can take a course of "smoldering" encephalitis. FDG-PET and electroencephalogram findings can reflect the disease activity degree in such patients, although with certain neurophysiological and biochemical distinctions.
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Affiliation(s)
- Masahiro Nagano
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Mayumi Yamada-Otani
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Akira Kuzuya
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Riki Matsumoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Jiro Oita
- Department of Neurology, Shimizu Hospital, Japan
| | - Makoto Yoneda
- Faculty of Nursing and Social Welfare Sciences, Fukui Prefectural University, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
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Geis C, Planagumà J, Carreño M, Graus F, Dalmau J. Autoimmune seizures and epilepsy. J Clin Invest 2019; 129:926-940. [PMID: 30714986 DOI: 10.1172/jci125178] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The rapid expansion in the number of encephalitis disorders associated with autoantibodies against neuronal proteins has led to an incremental increase in use of the term "autoimmune epilepsy," yet has occurred with limited attention to the physiopathology of each disease and genuine propensity to develop epilepsy. Indeed, most autoimmune encephalitides present with seizures, but the probability of evolving to epilepsy is relatively small. The risk of epilepsy is higher for disorders in which the antigens are intracellular (often T cell-mediated) compared with disorders in which the antigens are on the cell surface (antibody-mediated). Most autoantibodies against neuronal surface antigens show robust effects on the target proteins, resulting in hyperexcitability and impairment of synaptic function and plasticity. Here, we trace the evolution of the concept of autoimmune epilepsy and examine common inflammatory pathways that might lead to epilepsy. Then, we focus on several antibody-mediated encephalitis disorders that associate with seizures and review the synaptic alterations caused by patients' antibodies, with emphasis on those that have been modeled in animals (e.g., antibodies against NMDA, AMPA receptors, LGI1 protein) or in cultured neurons (e.g., antibodies against the GABAb receptor).
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Affiliation(s)
- Christian Geis
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jesus Planagumà
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and
| | - Mar Carreño
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francesc Graus
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and.,Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Josep Dalmau
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and.,Hospital Clinic, University of Barcelona, Barcelona, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.,Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Uwatoko H, Yabe I, Sato S, Abe M, Shirai S, Takahashi I, Matsushima M, Kano T, Yamaguchi S, Hatanaka KC, Yoneda M, Sasaki H. Hashimoto's encephalopathy mimicking a brain tumor and its pathological findings: A case report. J Neurol Sci 2018; 394:141-143. [DOI: 10.1016/j.jns.2018.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 11/28/2022]
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