Acute confusional state caused by Hashimoto's encephalopathy in a patient with hypothyroidism: a case report

A Patient with Hashimoto's Encephalopathy Presenting with Convulsive Seizure Alone as the Initial Symptom

A 71-year-old Japanese woman with Sjögren syndrome, Hashimoto’s disease and a 6-month history of cognitive impairment was admitted to our hospital because of consciousness disturbance and convulsion. Her convulsive seizure disappeared by intravenous administration of diazepam following carbamazepine, and conscious level became alert the next day. But, her cognitive function was persistently deteriorated, and a score of mini-mental state examination (MMSE) was 17/30 points. Magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) of the brain did not show any abnormal findings. The electroencephalogram showed increased slow waves in bilateral parieto-occipital regions. Serum anti-thyroglobulin antibodies were elevated (1780 U/ml), but thyroid function was within the normal range. In addition, anti-NAE (NH2-terminal of α-enolase) antibodies were positive. We diagnosed Hashimoto’s encephalopathy, and started steroid therapy. Her cognitive function gradually improved after steroid therapy, and convulsive seizure did not recur until 3 months later.

We emphasize that Hashimoto’s encephalopathy should be considered even in patients with convulsive seizure of adult onset without thyroid dysfunction.

Engineering case report. Toluene and methyl ethyl ketone exposure from a commercially available contact adhesive

A maintenance worker became ill after working indoors over the course of 3 days with a commercially available contact adhesive containing toluene and methyl ethyl ketone. Respiratory protection or local exhaust ventilation was not used. The worker subsequently suffered from numerous medical symptoms including tremors and elevated blood pressure. Magnetic resonance imaging documented the occurrence of encephalopathy. The worker has alleged that the cause of these effects was exposure to the vapors from the contact adhesive. The objective of this study was to characterize/estimate the level of the worker's exposure by obtaining air samples in an exposure chamber while performing similar activities under similar conditions. We found that the worker may have been exposed to approximately 159 ppm toluene and 58 ppm methyl ethyl ketone 8-hr time-weighted averages for 8 hr of adhesive application. The maximum 15-min average exposures were 233 ppm toluene and 85 ppm methyl ethyl ketone.