1 / 10

Hashimoto’s Encephalitis

Hashimoto’s Encephalitis. Jamie Parrott, MD Carolinas Medical Center Dept. of Neurology. Hashimoto’s Thyroiditis. Chronic autoimmune thyroiditis seen in 8% of females, 3% of males, 10% of females over 55y Hashimoto’s (chronic lymphocytic) thyroiditis is the most common form

bowen
Download Presentation

Hashimoto’s Encephalitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Hashimoto’s Encephalitis Jamie Parrott, MD Carolinas Medical Center Dept. of Neurology

  2. Hashimoto’s Thyroiditis • Chronic autoimmune thyroiditis seen in 8% of females, 3% of males, 10% of females over 55y • Hashimoto’s (chronic lymphocytic) thyroiditis is the most common form • Most common cause of sporatic goiter in children (1.2% prevalence)

  3. Hashimoto’s Thyroiditis • Exponential increase in last 40 years • T-cell mediated • Usually asymptomatic • Present with hypothyroidism (20%), goiter, or both • 5% incidence of hypothyroidism per year following diagnosis • 95% Female, usually between ages 30-50y

  4. Hashimoto’s Thyroiditis • Thyroid antibodies targeted • Thyroglobulin • Thyroid microsomal antigen (thyroid peroxidase) • TSH receptor • Association with type I DM, multiple sclerosis, rheumatoid arthritis, Turner syndrome, celiac disease, vitaligo

  5. Hashimoto’s Encephalitis • Rare condition associated with HT • 2 to 3 per 100,000 prevalence • Triad of encephalopathy, high serum antithyroid antibodies, and responsiveness to steroids • Majority euthyroid • 82% female • All pediatric case reports female, 9-18y

  6. Hashimoto’s Encephalitis • Two distinct patterns • Acute type characterized by seizures, stroke-like episodes with transient neurologic deficits, altered mental status. Recurrent. • Subacute with insidious onset over weeks. Confusion, agitation, restless, hallucinations, dementia in the absence of focal neurologic deficits • No relationship with presence of hypothyroidism and severity of symptoms

  7. Hashimoto’s Encephalitis • Possible underlying mechanisms • CNS autoimmune vasculitis (lymphocytic perivascular infiltrate seen pathologically in 2 of 9 patients, Odie et al) • Formation of antineural antibodies (Archambeaud et al; alpha enolase ab, Ochi et al; antithyroid antibody titers in CSF not related to severity of disease)

  8. Hashimoto’s Encephalitis • Severity of symptoms unrelated to antibody titers, thyroid function • Reported symptoms: seizures, myoclonus, Stiff-limb syndrome, stroke-like symptoms, cerebellar dysfunction, psychosis, confusion, depression, headache, hypothermia, coma

  9. Hashimoto’s Encephalitis • CSF protein elevated 75% • CSF pleocytosis 25% • EEG changes nonspecific (slowing) • MRI typically normal (occasional T2-weighted abnormalities)

  10. Hashimoto’s Encephalitis • Rapid response to steroids • Full recovery 3-4 weeks • Acute form is frequently recurrent, consider prophylaxis

More Related