Patients with Hashimoto encephalitis may present
with seizures, stroke-like episodes, transient focal and global neurological
deficits, and a variety of neuropsychiatric disturbances. The encephalopathy
evolves with elevated anti-thyroid peroxidase antibodies, independent of
hormonal thyroid function. A teenager experienced repeated concussions
antedating onset of Hashimoto encephalopathy. Neuroradiological studies showed
overlapping areas of altered brain metabolism and vascular perfusion in the
hippocampus, deemed most vulnerable in autoimmune encephalopathy. Concussive
brain injurymay be a contributing factor in the development of
encephalopathy due to its capacity to alter the blood-brain barrier.
References
[1]
Younger, D.S. (2017) Hashimoto’s Thyroiditis and Encephalopathy. World Journal of Neuroscience, 7, 307-326. https://doi.org/10.4236/wjns.2017.73026
[2]
Brain, L., Jellinek, E.H. and Ball, K. (1966) Hashimoto’s Disease and Encephalopathy. Lancet, 288, 512-514. https://doi.org/10.1016/S0140-6736(66)92876-5
[3]
Jellinek, E.H. and Ball, K. (1976) Hashimoto’s Disease, Encephalopathy, and Splenic Atrophy. Lancet, 307, 1248. https://doi.org/10.1016/S0140-6736(76)92207-8
[4]
Chong, J.Y., Rowland, L.P. and Utiger, R.D. (2003) Hashimoto Encephalopathy. Syndrome or Myth? Archives of Neurology, 60, 164-171.
https://doi.org/10.1001/archneur.60.2.164
[5]
Nolte, K.W., Unbehaun, A., Sieker, H., et al. (2000) Hashimoto Encephalopathy: A Brainstem Encephalitis? Neurology, 54, 769-770.
https://doi.org/10.1212/WNL.54.3.769
[6]
Shibata, N., Yamamoto, Y., Sunami, N., et al. (1992) Isolated Angiitis of the CNS Associated with Hashimoto’s Disease. Rinsho Shinkeigaku, 32, 191-198.
[7]
Ochi, H., Horiuchi, I., Araki, N., et al. (2002) Proteomic Analysis of Human Brain Identifies α-Enolase as a Novel Autoantigen in Hashimoto’s Encephalopathy. FEBS Letters, 528, 197-202. https://doi.org/10.1016/S0014-5793(02)03307-0
[8]
Kishitani, T., Matsunaga, A., Masamichi, I., et al. (2017) Limbic Encephalitis Associated with Anti-NH2-Terminal of α-Enolase Antibodies. A Clinical Subtype of Hashimoto Encephalopathy. Medicine, 96, e6181.
[9]
Graus, F., Titulaer, M.J., Balu, R., et al. (2016) A Clinical Approach to Diagnosis of Autoimmune Encephalitis. Lancet Neurology, 15, 391-404.
https://doi.org/10.1016/S1474-4422(15)00401-9
[10]
Bien, C.G., Vincent, A., Barnett, M.H., et al. (2012) Immunopathology of Autoantibody-Associated Encephalitides: Clues for Pathogenesis. Brain, 135, 1622-1638.
https://doi.org/10.1093/brain/aws082
[11]
Tagge, C.A., Fisher, A.M., Minaeva, O.V., et al. (2018) Concussion, Microvascular Injury, and Early Tauopathy in Young Athletes after Impact Head Injury and an Impact Concussion Mouse Model. Brain, 141, 422-458.
https://doi.org/10.1093/brain/awx350
