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Hashimoto's Encephalopathy Presenting with Smoldering Limbic Encephalitis
Masahiro Nagano1, Katsuya Kobayashi1, Mayumi Yamada-Otani1
1Department of Neurology, Kyoto University Graduate School of Medicine, Japan.
Internal Medicine (Tokyo, Japan)
|April 16, 2019
Summary
Hashimoto's encephalopathy can present as a smoldering limbic encephalitis. Advanced imaging and EEG help monitor disease activity, with PET scans showing improvement after steroid treatment.
Area of Science:
- Neurology
- Endocrinology
- Immunology
Background:
- Hashimoto's encephalopathy (HE) is an autoimmune brain disorder linked to Hashimoto's thyroiditis.
- It is typically responsive to steroid treatment.
Observation:
- A case of HE presented with persistent limbic encephalitis symptoms and examination abnormalities.
- Despite initial treatment, hippocampal hyperactivity on FDG-PET and subclinical seizures on EEG remained.
Findings:
- Additional prednisolone therapy reduced hippocampal hyperactivity on FDG-PET.
- FDG-PET and EEG can indicate disease activity in HE, reflecting specific neurophysiological and biochemical characteristics.
Implications:
- Hashimoto's encephalopathy may follow a 'smoldering' clinical course, similar to other autoimmune limbic encephalitides.
- FDG-PET and EEG are valuable tools for assessing disease activity and treatment response in HE.