A Case of Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis (Hashimoto's Encephalopathy)

Steroide yanıt veren otoimmün tiroiditle ilgili ensefalopati olgusu (Hashimoto Hashimoto enfesalopatisi (HE); nöropsikiyatrik semptomlar ve yüksek antitiroid antikor seviyeleri ile karakterize olan, kendine özgü radyolojik ya da EEG bulguları olmayan ve steroid tedavisiyle hızlı bir klinik düzelme gözlenen bir bozukluktur. HE; konfüzyon, stupor, koma, inme benzeri tablolar, titreme, epileptik nöbetler, miyoklonus, davranış değişiklikleri, varsanı ve hezeyan gibi pek çok farklı klinik görünümlerle ortaya çıkabilmektedir. Hastalığın kadınlarda daha sık görülmesi, beyin omurilik sıvısında enflamasyon bulgularına rastlanabilmesi, steroid tedavisine iyi yanıt vermesi ve diğer otoimmüne hastalıklarla birlikte görülebilmesi otoimmünitenin bu bozukluğun gelişiminde üzerinde önemle durulması gereken bir olgu olduğunu düşündürmektedir. HE'nin geniş bir yelpazeyi içeren klinik görünümlerle kendini gösterebilmesi, spesifik görüntüleme bulgularının olmaması, patogenezinin henüz tam olarak anlaşılamamasından dolayı bu sendroma ilişkin tanı koymada gecikilebileceği hatta bazı olgularda bu tanının atlanabileceği, erken tanı konulması halinde ise steroid tedavisiyle hızlı ve dramatik bir iyileşme gözlenebileceği düşünülmektedir. Bu vaka sunumunda kliniğimize kognitif bozukluk ve psikotik bulgularla başvuran ve HE tanısıyla takip edilen bir olgu bildirilmektedir.

Steroide yanıt veren otoimmün tiroiditle ilgili ensefalopati olgusu (Hashimoto ensefalopatisi)

Hashimoto's encephalopathy (HE) is a syndrome which represents itself with diverse neuropsychiatric symptoms and high titers of antithyroid antibodies, the syndrome has no specific radiological or EEG findings, and it can be dramatically resolved with corticosteroid treatment. HE can show different clinical findings such as, confusion, stupor, coma, stroke like episodes, epileptic seizures, myoclonus, behavioral changes, hallucinations and delusions. The cause of HE has been proposed to be autoimmune because of it's association with other immunologic disorders, female predominance, inflammatory findings in cerebrospinal fluid and response to treatment with streoids. Because the disease has a wide range of symptom scala and has no specific radiological findings and also has no proven pathogenetic mechanism that can explain the occurence of the disease it is thought that the diagnosis of the syndrome can be delayed or the disease can be misdiagnosed. This knowledge is thought to be crucial as we know that corticosteroid treatment can lead to quick and dramatic response when the syndrome is diagnosed early. In this case report, a patient who applied to our clinic with findings of cognitive and psychotic disturbances and was followed up with the HE diognosis is presented.

Kaynakça

Brain L, Jelinek EH, Ball K. Hashimoto disease and encephalopathy. Lancet 1966; 2:512-514. [CrossRef]

Ferraci F, Bertiato G, Moretto G. Hashimoto's encephalopathy: epidemiologic data and pathogenetic considerations. J Neurol Sci 2004; 217:165-168. [CrossRef]

Chong JY, Rowland LP, Utiger RD. Hashimoto encephalopathy: syndrome or myth? Arch Neurol 2003; 60:164-171. [CrossRef]

Watemberg N, Greenstein D, Levine A. Encephalopathy associated with Hashimoto thyroiditis: pediatric perspective. J Child Neurol 2006; 21:1-5. [CrossRef]

Kothbauer-Margreiter I, Sturzenegger M, Komor J, Baumgartner R, Hess CW. Encephalopathy associated with Hashimoto thyroiditis: diagnosis and treatment. J Neurol 1996; 243:585-593. [CrossRef]

Schiess N, Pardo CA. Hashimoto's encephalopathy. Ann N Y Acad Sci 2008; 1142:254-265. [CrossRef]

Anand KS, Garg J, Verma R, Chakrabotry A. Hashimoto's encephalitis: Unusual cause of reversible dementia. J Family Med Prim Care 2014; 3:284-286. [CrossRef]

Colakoglu BD, Koca PK, Yener G. Reversible cognitive disorder accompanying Hashimoto thyroiditis. Archives of Neuropsychiatry 2008; 45:19-20. (Turkish)

Alp R, Saygin M, Ucisik M, Caliskan M. Initial presentation of Hashimoto's thyroiditis with psychotic symptoms: a case report. Bulletin of Clinical Psychopharmacology 2004; 14:83-87. (Turkish)

Archambeaud F, Galinat S, Regouby Y, Magy L, Rebeyrotte I, Vallat JM, Teissier MP. Hashimoto encephalopathy: Analysis of four case reports. Rev Med Interne 2001; 22:653-659. [CrossRef]

Ecemis GC, Colak R. Thyroiditis. J Exp Clin Med 2012; 29(Suppl):321-327. (Turkish)

Ferracci F, Carnevale A. The neurological disorder associated with thyroid autoimmunity. J Neurol 2006; 253:975-984. [CrossRef]

Fujii A, Yoneda M, Ito T, Yamamura O, Satomi S, Higa H, Kimura A, Suzuki M, Yamashita M, Yuasa T, Suzuki H, Kuriyama M. Autoantibodies against the amino terminal of alpha-enolase are a useful diagnostic marker of Hashimoto's encephalopathy. J Neuroimmunol 2005; 162:130-136. [CrossRef]

Forchetti CM, Katsamakis G, Garron DC. Autoimmune thyroiditis and a rapidly progressive dementia: global hypoperfusion on SPECT scanning suggests a possible mechanism. Neurology 1997; 49:623-626. [CrossRef]

Pellicciari A, Cordelli DM, Leo I, Di Pietro E, Aldrovandi A, Franzoni E. Pyschotic episode during steroid therapy in Hashimoto encephalopathy. J Neuropsychiatry Clin Neurosci 2012; 24:E45-46. [CrossRef]

Tamagno G, Federspil G, Murialdo G. Clinical and diagnostic aspects of encephalopathy associated with autoimmune thyroid disease (or Hashimoto's encephalopathy). Intern Emerg Med 2006; 1:15-23. [CrossRef]

Chang JS, Chang TC. Hashimoto's encephalopathy: report of three cases. J Formos Med Assoc 2014; 113:862-866. [CrossRef]

Tamagno G, Celik Y, Simo R, Dihne M, Kimura K, Gelosa G, Lee BI, Hommet C, Murialdo G. Encephalopathy associated with autoimmune thyroid disease in patients with Graves' disease: clinical manifestations, follow-up, and outcomes. BMC Neurol 2010; 10:27. [CrossRef]

Dogan P, Sen A, Ulker M, Sari S, Atakli D, Arpaci B. Paraneoplastic limbic encephalitis: a case report. Balkan Medical Journal 2010; 27:98-100. (Turkish)

Kaynak Göster

  • ISSN: 1018-8681
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1984

6b 3.6b

Sayıdaki Diğer Makaleler

Psychiatric Symptoms, Perceived Social Support, Coping Styles, and Dyadic Adjustment in Pregnant Women with Hyperemesis Gravidarum

Nalan KARA, Müberra Namlı KALEM, Hatice BALCI, ZİYA KALEM, Ebru YÜCE, Zehra Candan DUVAN İLTEMUR

Capgras Syndrome After Use of Synthetic Cannabinoids: an Adolescent Case

ÜRÜN ÖZER ÇERİ, VEYSİ ÇERİ, Cüneyt EVREN

The Relationship Between Obsessive Compulsive Disorder and Mental Contamination (MC): Psychometric Properties of Vancouver Obsessive Compulsive Inventory-MC Scale and Thought-Action Fusion-Contamination Scale

MÜJGAN İNÖZÜ MERMERKAYA, Ilgun BİLEKLİ, Fulya Ozcanli ULUKUT

Why is not Lithium Prescribed More Often? Here are the Reasons

Michael GİTLİN

Frequency of Domestic Violence in Psychiatric Patients and Related Factors

Sevda KORKMAZ, Tuba KORUCU, Sevler YILDIZ, Şüheda KAYA, Filiz İZCİ, Murad ATMACA

Evaluation of EMDR Therapy Efficacy in Treatment of Phantom Limb Pain

Ebru SİNİCİ

Prevalence and Factors Associated with Mild Cognitive Impairment on Screening in Older Malaysians

Khairiah K, Ching Siew MOOİ, Tengku Aizan HAMİD

Acute Psychotic Attack under Isoniazid Treatment: a Case Report

Gökhan UMUT, Bahar DERNEK, İlker KÜÇÜKPARLAK, Tuğba AYDIN, Nesrin KARAMUSTAFALIOĞLU, Fatma Nur KESİKTAŞ

Psychotherapy Perspective of Physicians and Psychiatric Patients

Memduha AYDIN, HÜLYA ERTEKİN, Tahsin ETLİ, Hatice Yardim OZAYHAN, İbrahim EREN

The Assessment of the Relationship between Problematic Internet Use and Parent-Adolescent Relationship Quality, Loneliness, Anger, and Problem Solving Skills

Gulen SAY, Ayşegül BATIGÜN DURAK