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.

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Düşünen Adam - Psikiyatri ve Nörolojik Bilimler Dergisi-Cover
  • ISSN: 1018-8681
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1984
  • Yayıncı: Kare Yayıncılık
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