[Hashimoto encephalopathy. Analysis of four case reports].
BACKGROUND
Encephalopathy associated with Hashimoto's thyroiditis has been recognized for more than 30 years and is probably underestimated.


METHODS
We report four patients with Hashimoto's thyroiditis who presented neurological or psychiatric features. There were three women and one man, with a mean age of 68 years. Neurological presentations were various: seizures, psychotic episodes, altered consciousness, hallucinations without usual aetiological diseases (infectious, metabolic, neoplasic, vascular, etc.). Neurological investigations (EEG, brain CT, magnetic resonance imaging) were unspecific. In all cases, a moderately high CSF protein level without pleocytosis was found. Patients presented slight hypothyroidism with high titers of antithyroperoxidase antibodies. Despite hormone therapy replacement, neurological features persisted. Outcome was favorable under steroid therapy.


CONCLUSIONS
Hashimoto's encephalopathy must be considered in the face of neuropsychiatric manifestations without obvious etiology. Pathogenic mechanisms are not clear but probably involve autoimmune cerebral vasculitis because of the efficacy of steroids.
Archambeaud
F
F
Service de médecine interne B et endocrinologie, hôpital du Cluzeau, 23, avenue D.-Larrey, 87042 Limoges, France.
Galinat
S
S
Regouby
Y
Y
Magy
L
L
Rebeyrotte
I
I
Vallat
J M
JM
Teissier
M P
MP
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000209:etiology*; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D003128:Coma / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000209:etiology*; D004569:Electroencephalography; D005260:Female; D006212:Hallucinations / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000209:etiology*; D020249:Hormone Replacement Therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000209:etiology*; D019965:Neurocognitive Disorders / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000209:etiology*; D011618:Psychotic Disorders / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000209:etiology*; D012640:Seizures / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000209:etiology*; D013256:Steroids; D013963:Thyroid Hormones / Q000627:therapeutic use; D013967:Thyroiditis, Autoimmune / Q000145:classification / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D002556:Cerebrospinal Fluid Proteins; D013256:Steroids; D013963:Thyroid Hormones
Encéphalopathie de Hashimoto. Analyse de quatre observations.