Subacute cognitive deterioration with high serum anti-thyroid peroxidase antibodies: two cases and a plea for pragmatism.
Autoimmune encephalopathy is a rare but potentially reversible cause of cognitive deterioration and neuropsychiatric disturbances. We describe two older female patients with subacute cognitive decline and marked neuropsychiatric disturbances in the presence of high serum anti-thyroid peroxidase antibodies and with normal dosage of free thyroxine 4. One patient recovered almost completely after oral corticotherapy. Differential diagnosis and the role of biomarkers, in particular, are discussed. We support a pragmatic approach involving a short empirical therapeutic trial with intravenous or oral corticoids; this should be considered in all patients with subacute encephalopathy and with laboratory arguments for an underlying autoimmune aetiology.
Neurology Department, Brugmann University Hospital, Brussels, Belgium.
Kurt
K
Segers
Philippe
P
Braconnier
Francis
F
Corazza
Luisa
L
Divano
Asmaa
A
Mabrouk
Jean
J
Robberecht
Murielle
M
Surquin
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001927:Brain Diseases / Q000097:blood* / Q000150:complications* / Q000188:drug therapy; D003072:Cognition Disorders / Q000097:blood* / Q000150:complications* / Q000188:drug therapy; D003937:Diagnosis, Differential; D004660:Encephalitis; D005260:Female; D050031:Hashimoto Disease / Q000097:blood* / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007453:Iodide Peroxidase / Q000097:blood*; D008775:Methylprednisolone / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D001323:Autoantibodies; D015415:Biomarkers; C056626:thyroid microsomal antibodies; D007453:Iodide Peroxidase; D008775:Methylprednisolone
Hashimoto's encephalopathy; anti-thyroid peroxidase antibodies; autoimmune encephalopathy; dementia