Hashimoto’s encephalitis as a differential diagnosis of Creutzfeldt-Jakob disease

OBJECTIVES During an epidemiological study of Creutzfeldt-Jakob disease in Germany, Hashimoto’s encephalitis was encountered as a differential diagnosis, which has not yet been described in this context. METHODS The symptoms and findings of seven patients who fulfilled the criteria for “possible”Creutzfeldt-Jakob disease are presented. RESULTS A Hashimoto’s thyroiditis with antibodies against thyroglobulin or thyroid peroxidase, or both and a hypoechoic thyroid ultrasonogram were found in all cases. Analysis of CSF disclosed an increased leucocyte count in three patients, and a raised CSF:serum concentration ratio of albumin (QAlb) in four patients. The 14–3–3 protein, typical of Creutzfeldt-Jakob disease, could not be detected in any of our patients. No periodic sharp wave complexes, which are typical of Creutzfeldt-Jakob disease, were detected on EEG in any of the cases. By contrast with Creutzfeldt-Jakob disease, which leads to death within a few months, the patients with Hashimoto’s encephalitis often recover quickly when treated adequately. All the patients improved after administration of corticosteroids. CONCLUSION The clinical symptomatology of both diseases may be very similar: dementia, myoclonus, ataxia, and personality change or psychotic phenomena are characteristic symptoms.