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A patient with steroid responsive encephalopathy associated with autoimmune thyroiditis.

Abstract

We present a 58-year-old female with gradual cognitive decline and gait instability over 6 months. Her motor examination was notable for myoclonus, brisk reflexes with flexor plantar responses, and a cautious gait without ataxia. Cognitive testing revealed mildly impaired attention, but profoundly impaired calculation, judgment and visual memory. There were no manifestations of autoimmune thyroid disease. Routine laboratory analysis was unrevealing. Cerebrospinal fluid analysis was remarkable only for an elevated protein of 0.64 g/L (normal <0.45 g/L). Electroencephalography demonstrated intermittent bitemporal slowing. Brain MRI with gadolinium demonstrated extensive bilateral subcortical and periventricular white matter T2-weighted and hyperintensity on fluid attenuated inversion recovery MRI. Elevated anti-thyroperoxidase antibody of 8.07 IU/mL (<5.61 IU/mL) and thyroglobin antibody of 9.85 IU/mL (<4.11 IU/mL) were found and steroid responsive encephalopathy associated with autoimmune thyroiditis was diagnosed. Methylprednisolone (1 g daily for 3 days) resulted in dramatic improvement in cognition and mobility, which remained on follow-up.

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  • Authors+Show Affiliations

    ,

    Department of Neurology, Austin Health, Studley Road, Heidelberg, Victoria 3084, Australia. bktsang@optusnet.com.au

    ,

    Source

    MeSH

    Antibodies
    Brain Diseases
    Cognition Disorders
    Electroencephalography
    Female
    Glucocorticoids
    Humans
    Magnetic Resonance Imaging
    Methylprednisolone
    Middle Aged
    Peroxidase
    Thyroglobulin
    Thyroiditis, Autoimmune
    Tomography, X-Ray Computed

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    22884222

    Citation

    Tsang, Benjamin K-T, et al. "A Patient With Steroid Responsive Encephalopathy Associated With Autoimmune Thyroiditis." Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, vol. 19, no. 10, 2012, pp. 1459-61.
    Tsang BK, Crump N, Hughes AJ. A patient with steroid responsive encephalopathy associated with autoimmune thyroiditis. J Clin Neurosci. 2012;19(10):1459-61.
    Tsang, B. K., Crump, N., & Hughes, A. J. (2012). A patient with steroid responsive encephalopathy associated with autoimmune thyroiditis. Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, 19(10), pp. 1459-61. doi:10.1016/j.jocn.2012.02.014.
    Tsang BK, Crump N, Hughes AJ. A Patient With Steroid Responsive Encephalopathy Associated With Autoimmune Thyroiditis. J Clin Neurosci. 2012;19(10):1459-61. PubMed PMID: 22884222.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A patient with steroid responsive encephalopathy associated with autoimmune thyroiditis. AU - Tsang,Benjamin K-T, AU - Crump,Nicholas, AU - Hughes,Andrew J, Y1 - 2012/08/11/ PY - 2012/02/17/received PY - 2012/02/24/accepted PY - 2012/8/14/entrez PY - 2012/8/14/pubmed PY - 2013/2/13/medline SP - 1459 EP - 61 JF - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia JO - J Clin Neurosci VL - 19 IS - 10 N2 - We present a 58-year-old female with gradual cognitive decline and gait instability over 6 months. Her motor examination was notable for myoclonus, brisk reflexes with flexor plantar responses, and a cautious gait without ataxia. Cognitive testing revealed mildly impaired attention, but profoundly impaired calculation, judgment and visual memory. There were no manifestations of autoimmune thyroid disease. Routine laboratory analysis was unrevealing. Cerebrospinal fluid analysis was remarkable only for an elevated protein of 0.64 g/L (normal <0.45 g/L). Electroencephalography demonstrated intermittent bitemporal slowing. Brain MRI with gadolinium demonstrated extensive bilateral subcortical and periventricular white matter T2-weighted and hyperintensity on fluid attenuated inversion recovery MRI. Elevated anti-thyroperoxidase antibody of 8.07 IU/mL (<5.61 IU/mL) and thyroglobin antibody of 9.85 IU/mL (<4.11 IU/mL) were found and steroid responsive encephalopathy associated with autoimmune thyroiditis was diagnosed. Methylprednisolone (1 g daily for 3 days) resulted in dramatic improvement in cognition and mobility, which remained on follow-up. SN - 1532-2653 UR - https://www.unboundmedicine.com/medline/citation/22884222/abstract/A_patient_with_steroid_responsive_encephalopathy_associated_with_autoimmune_thyroiditis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0967-5868(12)00146-4 DB - PRIME DP - Unbound Medicine ER -