An autoimmune cause of confusion in a patient with a background of hypothyroidism
A 68-year-old previously independent woman presented multiple times to hospital over the course of 3 months with a history of intermittent weakness, vacant episodes, word finding difficulty and reduced cognition. She was initially diagnosed with a TIA, and later with a traumatic subarachnoid haemo...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Bioscientifica
2019-05-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2019/1/EDM19-0014.xml |
| Summary: | A 68-year-old previously independent woman presented multiple times to hospital over the course of 3 months with a history
of intermittent weakness, vacant episodes, word finding difficulty and reduced cognition. She was initially diagnosed with a
TIA, and later with a traumatic subarachnoid haemorrhage following a fall; however, despite resolution of the haemorrhage,
symptoms were ongoing and continued to worsen. Confusion screen blood tests showed no cause for the ongoing symptoms.
More specialised investigations, such as brain imaging, cerebrospinal fluid analysis, electroencephalogram and serology also gave no clear diagnosis. The patient had a background of hypothyroidism, with plasma thyroid function tests throughout
showing normal free thyroxine and a mildly raised thyroid-stimulating hormone (TSH). However plasma anti-thyroid
peroxidise (TPO) antibody titres were very high. After discussion with specialists, it was felt she may have a rare and poorly
understood condition known as Hashimoto’s encephalopathy (HE). After a trial with steroids, her symptoms dramatically
improved and she was able to live independently again, something which would have been impossible at presentation. |
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| ISSN: | 2052-0573 2052-0573 |