Şule Aydın TÜRKOĞLU, Elif Sultan BOLAÇ, Tarık EROĞLU, Serpil YILDIZ, Nebil YILDIZ

Pseudotümör Serebri Kliniği ile Presente Olan Hashimoto Ensefalopatili Bir Olgu Sunumu

Hashimoto ensefalopatisi, otoimmün etyolojiye bağlı olduğu düşünülen ve yüksek antitiroid antikorları ile birlikte seyreden bir ensefalopati tablosudur. Klinik görünüm global amnezi, psikoz, kognitif etkilenme, epileptik nöbetler şeklinde olabilmektedir. Burada kliniğimize iki yanlı görme bozukluğu, baş ağrısı, davranış değişikliği, uyku düzensizliği şikayeti ile başvuran ve muayenesinde iki yanlı papil ödem saptanıp Pseudotumör serebri PTS tanısıyla servisimizde takip edilen 69 yaşında bir kadın hasta sunulacaktır. Etiyolojiye yönelik yapılan tetkiklerinde Hashimato Tiroiditi harici özellik saptanmayan hastaya iki kez yapılan boşaltıcı lomber ponksiyon LP ve 5 gün süreyle 1 gr/gün IV metilprednisolon tedavisi uygulanmış ve hastada klinik düzelme gözlenmiştir. PTS tablosuna nadiren Hashimoto ensefalopatisi sebep olması nedeniyle olgumuzu sunmayı uygun gördük.

Anahtar Kelimeler:

Pseudotumör serebri, Hashimoto ensefalopatisi, tiroidit, bilişsel bozulma

Hashimoto Encephalitis Presented With Clinical Manifestations of Pseudotumor Cerebri: A Case Report

Hashimoto encephalopathy is an encephalopathy associated with high antithyroid antibodies and it is thought to be connected with autoimmune etiology. Clinical presentation may be in the forms of global amnesia, psychosis, cognitive impairment and epileptic seizures. Herein, we will present a case of a 69-year-old female patient who applied to our clinic with bilateral visual impairment, headache, behavioral changes, sleep disorders, bilateral papilledema and established diagnosis of pseudotumor cerebri. As an etiological factor, only Hashimoto thyroiditis was determined. Drainage with lumbar puncture was performed for two times and IV methylprednisolone treatment at daily doses of 1 g was administered for 5 days with resultant clinical improvement. We wanted to present our case of Hashimoto encephalopathy as a rarely seen etiological factor of pseudotumor cerebri.

Keywords:

Pseudotumor cerebri, Hashimoto encephalopathy, thyroiditis, cognitive dissonance,

PDF

___

Dhungana S, Sharrack B, Woodroofe N. Idiopathic intracranial hypertension. Acta Neurologica Scandinavica 2010;121: 71-82.
Peng K, Fuh J, Wang S. High-pressure headaches: idiopathic intracranial hypertension and its mimics. Nature Reviews/ Neurology 2012;8:700-10.
Press OW, Ladenson PW. Pseudotumor Cerebri and hypothyroidism. Arch Intern Med. 1983 Jan;143(1):167-8.
Dickman MS, Somasundaram M, Brzozowski L. Pseudotumor cerebri and hyperthyroidism N Y State J Med. 1980 Jun;80(7 Pt 1):1118-20.
Van Dop C, Conte FA, Koch TK, Clark SJ, Wilson-Davis SL, Grumbach MM. Pseudotumor cerebri associated with initiation of levothyroxine therapy for juvenile hypothyroidism. N Engl J Med. 1983 May 5;308(18):1076-80.
Castillo P, Woodruff B, Caselli R, Vernino S, Lucchinetti C, Swanson J, et al. Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis. Arch Neurology 2006;63(2): 197-202.
Friedman DI Papilledema and idiopathic intracranial hypertension. Continuum (Minneap Minn). 2014 Aug;20(4 Neuro-ophthalmology):857-76.
Leyhe T, Müssig K. Cognitive and affective dysfunctions in autoimmune thyroiditis. Brain Behav Immun. 2014 Oct;41:261-6.
Adams C, Dean HJ, Israels SJ, Patton A, Fewer DH. Primary hypothyroidism with intracranial hypertension and pituitary Mar;10(2):166-8. Pediatr Neurol. 1994
Strickler C, Pilon AF. Presumed levothyroxine-induced pseudotumor cerebri in a pediatric patient being treated for congenital hypothyroidism. Clin Ophthalmol. 2007 Dec;1(4):545-9.
Huseman CA, Torkelson RD Pseudotumor cerebri following treatment of hypothalamic and primary hypothyroidism. Am J Dis Child. 1984 Oct;138(10):927-31.
Erden S, Buyukozturk S, Vural P, Değirmencioğlu S. Acute- phase reactans in Hashimoto thyroiditis. Int Immunopharmacol. 2008 Dec 20;8(13-14):1863-5.