[Case report of a patient with Hashimoto's encephalopathy associated with Basedow's disease mimicking Creutzfeldt-Jakob disease].
A 79-year-old female was admitted to our hospital because of unconsciousness and convulsion following mental deterioration. On admission, she exhibited myoclonic movement of the right side of the face and right fingers in addition to rigospasticity and tremors in the right arm and leg. Laboratory tests revealed hyperthyroidism with an increased anti-TSH-R antibody titer. In addition, an echogram indicated excessive blood flow at the thyroid; hence, the patient was diagnosed with Basedow's disease. Interestingly, the tests also revealed increased titer of anti-TPO antibody, anti-Tg antibody, and anti-NH2 terminal of alpha-enolase (NAE) antibody; in addition, an EEG showed abnormal findings potentially indicating periodic synchronous discharge. Brain MRI showed cerebral atrophy, and brain 99mTc-ECD-SPECT images demonstrated an overall decrease in the accumulation of 99mTc in the cerebrum. The abovementioned findings are common to patients with Creutzfeldt-Jakob disease (CJD). We initiated treatment for hyperthyroidism with thiamazole and lugol, but this did not regain consciousness. Because she had anti-thyroid antibody was observed, we considered a differential diagnosis of Hashimoto's encephalopathy and, in fact, methylprednisolone pulse therapy alleviated her symptoms and normalized the EEG findings. The condition in this case clinically mimicked CJD; therefore, the differentiated diagnosis is important because Hashimoto's encephalopathy is treatable disease.
Department of Neurology and Geriatrics, Division of Neuroscience, Research Field of Medical Sciences, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
Takeo
T
Sakurai
Yuji
Y
Tanaka
Akihiro
A
Koumura
Yuichi
Y
Hayashi
Akio
A
Kimura
Isao
I
Hozumi
Makoto
M
Yoneda
Takashi
T
Inuzuka
D000368:Aged; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D014408:Biomarkers, Tumor / Q000276:immunology; D001927:Brain Diseases / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D007562:Creutzfeldt-Jakob Syndrome; D004268:DNA-Binding Proteins / Q000276:immunology; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D050031:Hashimoto Disease / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000008:administration & dosage; D010751:Phosphopyruvate Hydratase / Q000276:immunology; D020551:Pulse Therapy, Drug; D015899:Tomography, Emission-Computed, Single-Photon; D025521:Tumor Suppressor Proteins / Q000276:immunology
D001323:Autoantibodies; D015415:Biomarkers; D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; D025521:Tumor Suppressor Proteins; C095157:ENO1 protein, human; D010751:Phosphopyruvate Hydratase; D008775:Methylprednisolone