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Hashimoto encephalopathy or neurosarcoidosis? A case report
Sarita K Sapkota1, Biggya L Sapkota2, Nataria Pitiyanuvath2
1Department of Medicine, UT college of Medicine Chattanooga, Chattanooga, TN, USA.
The Neurohospitalist
|April 2, 2015
Summary
Hashimoto encephalopathy (HE), a rare autoimmune disorder, can cause severe neurological symptoms like seizures and cognitive decline. Prompt diagnosis and treatment, such as with intravenous immunoglobulin, can lead to significant neurological improvement.
Area of Science:
- Neurology
- Immunology
- Autoimmune Diseases
Background:
- Hashimoto encephalopathy (HE) is a rare autoimmune neurological disorder associated with elevated antithyroid antibodies.
- Neurosarcoidosis is an uncommon manifestation of systemic sarcoidosis, often presenting with neurological deficits.
- Both conditions are rare and can present with overlapping or complex neurological symptoms.
Purpose of the Study:
- To report a case of a patient diagnosed with both Hashimoto encephalopathy and neurosarcoidosis.
- To highlight the diagnostic challenges and treatment response in a patient with overlapping rare neurological conditions.
- To emphasize the importance of considering HE in cases of unexplained encephalopathy and refractory seizures.
Main Methods:
- Case report of a 49-year-old woman with new-onset seizures and cognitive decline.
- Diagnostic workup included serological tests for antithyroid antibodies and pathological examination.
- Treatment involved antiepileptic drugs and a course of intravenous immunoglobulin (IVIg).
Main Results:
- The patient presented with refractory partial seizures and progressive neurocognitive decline.
- Seizures showed a positive response to intravenous immunoglobulin therapy.
- Diagnosis of Hashimoto encephalopathy and pulmonary sarcoidosis was confirmed through serological and pathological findings.
- Neurological improvement was observed following seizure control.
Conclusions:
- Hashimoto encephalopathy is an underrecognized, potentially treatable cause of encephalopathy with diverse neuropsychiatric manifestations.
- Diagnosis of HE is often a diagnosis of exclusion, requiring high clinical suspicion.
- This case underscores the importance of considering HE in the differential diagnosis of unexplained neurological symptoms, especially when associated with autoimmune markers.
