Multiple intracranial lesions as the unusual imaging features of Hashimoto's encephalopathy: A case report
Hashimoto's encephalopathy (HE) is associated with autoimmune thyroid disease and is complex, diverse, and easily misdiagnosed. However, if HE is diagnosed and treated in a timely manner, an optimal prognosis may be achieved. We presented a case of a 63-year-old female patient with paroxysmal d...
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| Veröffentlicht in: | Medicine (Baltimore) 2018-05, Vol.97 (21), p.e10814-e10814 |
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| creator | Kong, Fan-Xin Lu, Qing-Hong Guo, Zhou-Ke |
| description | Hashimoto's encephalopathy (HE) is associated with autoimmune thyroid disease and is complex, diverse, and easily misdiagnosed. However, if HE is diagnosed and treated in a timely manner, an optimal prognosis may be achieved.
We presented a case of a 63-year-old female patient with paroxysmal dizziness, unsteady gait, emotion apathy, progressive cognitive impairment, and unusual magnetic resonance imaging (MRI) findings.
After suffering for almost 8 years, the patient was diagnosed with HE based on clinical manifestation, abnormal electroencephalogram, unusual MRI findings, sensitivity to cortisol treatment, and characteristic high antithyroid peroxidase antibody (TpoAb) titer.
The patient continued regular glucocorticoids therapy after intravenous methylprednisolone pulse therapy, neurotrophic drugs, traditional Chinese medicine and rehabilitation to relieve hypermyotonia and cognitive impairment.
After combined treatment, the patient's symptoms, electroencephalogram (EEG), MRI, and the TpoAb titer gradually improved. However, the patient had to stop glucocorticoids treatment because of severe osteoporosis, fractures and other adverse reactions. Her symptoms fluctuated, and her TpoAb titer increased again.
HE may cause highly heterogeneous clinical features, particularly MRI findings. Withdrawal of the systematic glucocorticoids treatment can lead to varied outcomes in these patients. |
| doi_str_mv | 10.1097/MD.0000000000010814 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6393037</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>29794766</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3552-ba2b29e4fb1aeb330c07b7a4461b7b9791e62b0d22bc209b6479799fd58482163</originalsourceid><addsrcrecordid>eNpdUMtuFDEQtBARWQJfgIR84zTBb685IEUJEKSscknOlj3bs-PgHY9sD1H-HoeF8OhLS91V1dWF0BtKTikx-v3m4pT8KUrWVDxDKyq56qRR4jlaEcJkp40Wx-hlKXcNxDUTL9AxM9oIrdQK3W2WWMMcAYepZtdnNwUXcYQS0lSwK7iOgJdpKUsbh73bhWmHB3B1yVBwGvClK2PYp5reFQxTD_PoYppdHR8-4DPcuwI4w5xyfYWOBhcLvP7VT9Dt508355fd1fWXr-dnV13PpWSdd8wzA2Lw1IHnnPREe-2EUNRr34xTUMyTLWO-Z8R4JdqHxgxbuRZrRhU_QR8PuvPi97Dt4fGxaOfc3OcHm1yw_26mMNpd-m4VN5xw3QT4QaDPqZQMwxOXEvsYvd1c2P-jb6y3f5994vzOugHEAXCfYoVcvsXlHrIdwcU6_tST2rCOEbomkknStYlg_AcjfJD_</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Multiple intracranial lesions as the unusual imaging features of Hashimoto's encephalopathy: A case report</title><source>Wolters Kluwer Open Health</source><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>IngentaConnect Free/Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Kong, Fan-Xin ; Lu, Qing-Hong ; Guo, Zhou-Ke</creator><creatorcontrib>Kong, Fan-Xin ; Lu, Qing-Hong ; Guo, Zhou-Ke</creatorcontrib><description>Hashimoto's encephalopathy (HE) is associated with autoimmune thyroid disease and is complex, diverse, and easily misdiagnosed. However, if HE is diagnosed and treated in a timely manner, an optimal prognosis may be achieved.
We presented a case of a 63-year-old female patient with paroxysmal dizziness, unsteady gait, emotion apathy, progressive cognitive impairment, and unusual magnetic resonance imaging (MRI) findings.
After suffering for almost 8 years, the patient was diagnosed with HE based on clinical manifestation, abnormal electroencephalogram, unusual MRI findings, sensitivity to cortisol treatment, and characteristic high antithyroid peroxidase antibody (TpoAb) titer.
The patient continued regular glucocorticoids therapy after intravenous methylprednisolone pulse therapy, neurotrophic drugs, traditional Chinese medicine and rehabilitation to relieve hypermyotonia and cognitive impairment.
After combined treatment, the patient's symptoms, electroencephalogram (EEG), MRI, and the TpoAb titer gradually improved. However, the patient had to stop glucocorticoids treatment because of severe osteoporosis, fractures and other adverse reactions. Her symptoms fluctuated, and her TpoAb titer increased again.
HE may cause highly heterogeneous clinical features, particularly MRI findings. Withdrawal of the systematic glucocorticoids treatment can lead to varied outcomes in these patients.</description><identifier>ISSN: 0025-7974</identifier><identifier>EISSN: 1536-5964</identifier><identifier>DOI: 10.1097/MD.0000000000010814</identifier><identifier>PMID: 29794766</identifier><language>eng</language><publisher>United States: The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Administration, Intravenous ; Autoantibodies - metabolism ; Brain Diseases - complications ; Brain Diseases - diagnostic imaging ; Brain Diseases - pathology ; Clinical Case Report ; Cognitive Dysfunction - diagnosis ; Cognitive Dysfunction - etiology ; Dizziness - diagnosis ; Dizziness - etiology ; Electroencephalography ; Encephalitis - complications ; Encephalitis - diagnosis ; Encephalitis - metabolism ; Encephalitis - therapy ; Female ; Gait Disorders, Neurologic - diagnosis ; Gait Disorders, Neurologic - etiology ; Glucocorticoids - administration & dosage ; Glucocorticoids - adverse effects ; Glucocorticoids - therapeutic use ; Hashimoto Disease - complications ; Hashimoto Disease - diagnosis ; Hashimoto Disease - metabolism ; Hashimoto Disease - therapy ; Humans ; Magnetic Resonance Imaging ; Methylprednisolone - administration & dosage ; Methylprednisolone - adverse effects ; Methylprednisolone - therapeutic use ; Middle Aged ; Pulse Therapy, Drug - methods ; Tomography, X-Ray Computed ; Treatment Outcome</subject><ispartof>Medicine (Baltimore), 2018-05, Vol.97 (21), p.e10814-e10814</ispartof><rights>The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3552-ba2b29e4fb1aeb330c07b7a4461b7b9791e62b0d22bc209b6479799fd58482163</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393037/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393037/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29794766$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kong, Fan-Xin</creatorcontrib><creatorcontrib>Lu, Qing-Hong</creatorcontrib><creatorcontrib>Guo, Zhou-Ke</creatorcontrib><title>Multiple intracranial lesions as the unusual imaging features of Hashimoto's encephalopathy: A case report</title><title>Medicine (Baltimore)</title><addtitle>Medicine (Baltimore)</addtitle><description>Hashimoto's encephalopathy (HE) is associated with autoimmune thyroid disease and is complex, diverse, and easily misdiagnosed. However, if HE is diagnosed and treated in a timely manner, an optimal prognosis may be achieved.
We presented a case of a 63-year-old female patient with paroxysmal dizziness, unsteady gait, emotion apathy, progressive cognitive impairment, and unusual magnetic resonance imaging (MRI) findings.
After suffering for almost 8 years, the patient was diagnosed with HE based on clinical manifestation, abnormal electroencephalogram, unusual MRI findings, sensitivity to cortisol treatment, and characteristic high antithyroid peroxidase antibody (TpoAb) titer.
The patient continued regular glucocorticoids therapy after intravenous methylprednisolone pulse therapy, neurotrophic drugs, traditional Chinese medicine and rehabilitation to relieve hypermyotonia and cognitive impairment.
After combined treatment, the patient's symptoms, electroencephalogram (EEG), MRI, and the TpoAb titer gradually improved. However, the patient had to stop glucocorticoids treatment because of severe osteoporosis, fractures and other adverse reactions. Her symptoms fluctuated, and her TpoAb titer increased again.
HE may cause highly heterogeneous clinical features, particularly MRI findings. Withdrawal of the systematic glucocorticoids treatment can lead to varied outcomes in these patients.</description><subject>Administration, Intravenous</subject><subject>Autoantibodies - metabolism</subject><subject>Brain Diseases - complications</subject><subject>Brain Diseases - diagnostic imaging</subject><subject>Brain Diseases - pathology</subject><subject>Clinical Case Report</subject><subject>Cognitive Dysfunction - diagnosis</subject><subject>Cognitive Dysfunction - etiology</subject><subject>Dizziness - diagnosis</subject><subject>Dizziness - etiology</subject><subject>Electroencephalography</subject><subject>Encephalitis - complications</subject><subject>Encephalitis - diagnosis</subject><subject>Encephalitis - metabolism</subject><subject>Encephalitis - therapy</subject><subject>Female</subject><subject>Gait Disorders, Neurologic - diagnosis</subject><subject>Gait Disorders, Neurologic - etiology</subject><subject>Glucocorticoids - administration & dosage</subject><subject>Glucocorticoids - adverse effects</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Hashimoto Disease - complications</subject><subject>Hashimoto Disease - diagnosis</subject><subject>Hashimoto Disease - metabolism</subject><subject>Hashimoto Disease - therapy</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Methylprednisolone - administration & dosage</subject><subject>Methylprednisolone - adverse effects</subject><subject>Methylprednisolone - therapeutic use</subject><subject>Middle Aged</subject><subject>Pulse Therapy, Drug - methods</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><issn>0025-7974</issn><issn>1536-5964</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUMtuFDEQtBARWQJfgIR84zTBb685IEUJEKSscknOlj3bs-PgHY9sD1H-HoeF8OhLS91V1dWF0BtKTikx-v3m4pT8KUrWVDxDKyq56qRR4jlaEcJkp40Wx-hlKXcNxDUTL9AxM9oIrdQK3W2WWMMcAYepZtdnNwUXcYQS0lSwK7iOgJdpKUsbh73bhWmHB3B1yVBwGvClK2PYp5reFQxTD_PoYppdHR8-4DPcuwI4w5xyfYWOBhcLvP7VT9Dt508355fd1fWXr-dnV13PpWSdd8wzA2Lw1IHnnPREe-2EUNRr34xTUMyTLWO-Z8R4JdqHxgxbuRZrRhU_QR8PuvPi97Dt4fGxaOfc3OcHm1yw_26mMNpd-m4VN5xw3QT4QaDPqZQMwxOXEvsYvd1c2P-jb6y3f5994vzOugHEAXCfYoVcvsXlHrIdwcU6_tST2rCOEbomkknStYlg_AcjfJD_</recordid><startdate>20180501</startdate><enddate>20180501</enddate><creator>Kong, Fan-Xin</creator><creator>Lu, Qing-Hong</creator><creator>Guo, Zhou-Ke</creator><general>The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved</general><general>Wolters Kluwer Health</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20180501</creationdate><title>Multiple intracranial lesions as the unusual imaging features of Hashimoto's encephalopathy: A case report</title><author>Kong, Fan-Xin ; Lu, Qing-Hong ; Guo, Zhou-Ke</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3552-ba2b29e4fb1aeb330c07b7a4461b7b9791e62b0d22bc209b6479799fd58482163</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Administration, Intravenous</topic><topic>Autoantibodies - metabolism</topic><topic>Brain Diseases - complications</topic><topic>Brain Diseases - diagnostic imaging</topic><topic>Brain Diseases - pathology</topic><topic>Clinical Case Report</topic><topic>Cognitive Dysfunction - diagnosis</topic><topic>Cognitive Dysfunction - etiology</topic><topic>Dizziness - diagnosis</topic><topic>Dizziness - etiology</topic><topic>Electroencephalography</topic><topic>Encephalitis - complications</topic><topic>Encephalitis - diagnosis</topic><topic>Encephalitis - metabolism</topic><topic>Encephalitis - therapy</topic><topic>Female</topic><topic>Gait Disorders, Neurologic - diagnosis</topic><topic>Gait Disorders, Neurologic - etiology</topic><topic>Glucocorticoids - administration & dosage</topic><topic>Glucocorticoids - adverse effects</topic><topic>Glucocorticoids - therapeutic use</topic><topic>Hashimoto Disease - complications</topic><topic>Hashimoto Disease - diagnosis</topic><topic>Hashimoto Disease - metabolism</topic><topic>Hashimoto Disease - therapy</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Methylprednisolone - administration & dosage</topic><topic>Methylprednisolone - adverse effects</topic><topic>Methylprednisolone - therapeutic use</topic><topic>Middle Aged</topic><topic>Pulse Therapy, Drug - methods</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kong, Fan-Xin</creatorcontrib><creatorcontrib>Lu, Qing-Hong</creatorcontrib><creatorcontrib>Guo, Zhou-Ke</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Medicine (Baltimore)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kong, Fan-Xin</au><au>Lu, Qing-Hong</au><au>Guo, Zhou-Ke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multiple intracranial lesions as the unusual imaging features of Hashimoto's encephalopathy: A case report</atitle><jtitle>Medicine (Baltimore)</jtitle><addtitle>Medicine (Baltimore)</addtitle><date>2018-05-01</date><risdate>2018</risdate><volume>97</volume><issue>21</issue><spage>e10814</spage><epage>e10814</epage><pages>e10814-e10814</pages><issn>0025-7974</issn><eissn>1536-5964</eissn><abstract>Hashimoto's encephalopathy (HE) is associated with autoimmune thyroid disease and is complex, diverse, and easily misdiagnosed. However, if HE is diagnosed and treated in a timely manner, an optimal prognosis may be achieved.
We presented a case of a 63-year-old female patient with paroxysmal dizziness, unsteady gait, emotion apathy, progressive cognitive impairment, and unusual magnetic resonance imaging (MRI) findings.
After suffering for almost 8 years, the patient was diagnosed with HE based on clinical manifestation, abnormal electroencephalogram, unusual MRI findings, sensitivity to cortisol treatment, and characteristic high antithyroid peroxidase antibody (TpoAb) titer.
The patient continued regular glucocorticoids therapy after intravenous methylprednisolone pulse therapy, neurotrophic drugs, traditional Chinese medicine and rehabilitation to relieve hypermyotonia and cognitive impairment.
After combined treatment, the patient's symptoms, electroencephalogram (EEG), MRI, and the TpoAb titer gradually improved. However, the patient had to stop glucocorticoids treatment because of severe osteoporosis, fractures and other adverse reactions. Her symptoms fluctuated, and her TpoAb titer increased again.
HE may cause highly heterogeneous clinical features, particularly MRI findings. Withdrawal of the systematic glucocorticoids treatment can lead to varied outcomes in these patients.</abstract><cop>United States</cop><pub>The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>29794766</pmid><doi>10.1097/MD.0000000000010814</doi><oa>free_for_read</oa></addata></record> |
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| source | Wolters Kluwer Open Health; MEDLINE; DOAJ Directory of Open Access Journals; IngentaConnect Free/Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Administration, Intravenous Autoantibodies - metabolism Brain Diseases - complications Brain Diseases - diagnostic imaging Brain Diseases - pathology Clinical Case Report Cognitive Dysfunction - diagnosis Cognitive Dysfunction - etiology Dizziness - diagnosis Dizziness - etiology Electroencephalography Encephalitis - complications Encephalitis - diagnosis Encephalitis - metabolism Encephalitis - therapy Female Gait Disorders, Neurologic - diagnosis Gait Disorders, Neurologic - etiology Glucocorticoids - administration & dosage Glucocorticoids - adverse effects Glucocorticoids - therapeutic use Hashimoto Disease - complications Hashimoto Disease - diagnosis Hashimoto Disease - metabolism Hashimoto Disease - therapy Humans Magnetic Resonance Imaging Methylprednisolone - administration & dosage Methylprednisolone - adverse effects Methylprednisolone - therapeutic use Middle Aged Pulse Therapy, Drug - methods Tomography, X-Ray Computed Treatment Outcome |
| title | Multiple intracranial lesions as the unusual imaging features of Hashimoto's encephalopathy: A case report |
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