Hashimoto′s encephalopathy misdiagnosed as pyogenic meningoencephalitis

Hashimoto′s encephalopathy is a controversial and under-recognized condition, associated with autoimmune thyroiditis. Presentation may be an insidious development of cognitive impairment or recurrent acute episodes of focal neurological deficit with confusion. Here, we present a case of middle-aged female that presented with headache, vomiting with alteration of sensorium and left side weakness and responded well to steroids. A negative microbiological screen of the cerebrospinal fluid (CSF) and serum along with raised CSF protein, elevated serum antithyroid antibodies, and characteristic electroencephalographic and neuroimaging findings yielded the diagnosis.