title: Hashimoto encephalopathy or neurosarcoidosis? A case report.
abstract: Hashimoto encephalopathy (HE) is a rare autoimmune disease characterized by symptoms of acute or subacute encephalopathy associated with increased antithyroid antibody levels. Neurosarcoidosis is also a rare entity that occurs in less than 5% of patients with systemic sarcoidosis. Neurosarcoidosis usually presents with cranial neuropathies, myelopathy, or new-onset seizure. We report a case of a 49-year-old caucasian woman, previously healthy, who initially presented for a workup of a new-onset seizure. She had a gradually progressive course with neurocognitive decline and recurrent partial seizures refractory to conventional antiepileptic drugs. Her seizures responded well to a course of intravenous immunoglobulin. She was subsequently diagnosed with HE and pulmonary sarcoidosis based on serological and pathological studies. She improved neurologically once the seizures were controlled. Hashimoto encephalopathy is a rare condition that is potentially treatable and presents with various neuropsychiatric manifestations. It is a diagnosis of exclusion that requires a strong clinical suspicion and is often underrecognized.
authors.affiliation: Department of Medicine, UT college of Medicine Chattanooga, Chattanooga, TN, USA.
authors.forename: Sarita K
authors.initials: SK
authors.lastname: Sapkota
authors.affiliation: Southeast Regional Stroke Center at Erlanger Medical Center, Chattanooga, TN, USA.
authors.forename: Biggya L
authors.initials: BL
authors.lastname: Sapkota
authors.affiliation: Southeast Regional Stroke Center at Erlanger Medical Center, Chattanooga, TN, USA.
authors.forename: Nataria
authors.initials: N
authors.lastname: Pitiyanuvath
keywords: autoimmune diseases of the nervous system; central nervous system infections; clinical specialty; encephalitis; epilepsy; neuroimmunology
references.citation: J Neuropsychiatry Clin Neurosci. 2011 Fall;23 (4):384-90
references.pmid: 22231308
references.citation: J Neurol. 2006 Aug;253(8):975-84
references.pmid: 16786216
references.citation: Arch Neurol. 2001 Feb;58(2):225-30
references.pmid: 11176960
references.citation: Chest. 2006 Aug;130(2):526-32
references.pmid: 16899854
references.citation: FEBS Lett. 2002 Sep 25;528(1-3):197-202
references.pmid: 12297304
references.citation: J Neurol Sci. 2004 Feb 15;217(2):165-8
references.pmid: 14706219
references.citation: J Neurol. 1996 Aug;243(8):585-93
references.pmid: 8865025
references.citation: Neurology. 1991 Feb;41(2 ( Pt 1)):228-33
references.pmid: 1992366
references.citation: Mayo Clin Proc. 2010 Oct;85(10):881-97
references.pmid: 20884824
references.citation: Arch Neurol. 2003 Feb;60(2):164-71
references.pmid: 12580699
references.citation: Neurology. 1997 Aug;49(2):623-6
references.pmid: 9270613
references.citation: N Engl J Med. 1990 May 31;322(22):1555-60
references.pmid: 2135382