Clinical Analysis Of 10 Patients With Hashimoto's Encephalopathy

Objective: Hashimoto's Encephalopathy is a rare disorder in clinic.The international and multidisciplinary consensus have not yet worked out an unified diagnostic criteria.The purpose of this study is to explore the clinical characteristics of Hashimoto's Encephalopathy and enhance understanding of the disease and thus,clinicians could take rational treatment in time and improve patients' prognosis.Methods: The clinical data of 10 patients with Hashimoto's Encephalopathy were analyzed together with the general information,clinical presentations,laboratory,EEG,neuroimaging findings,diagnosis,and treatment.Summarizing and analysising the clinical characteristic of Hashimoto's Encephalopathy.Results: Among the 10 patients with Hashimoto's Encephalopathy,8 cases were female patients and 2 cases were male,1 case was a pediatric patient and 9 cases were adults.The age range of 9 adults was 19~60 years old,and the mean age was 42.4 years old.The clinical picture of HE is pleomorphic.In the course,acute onset of the symptoms in 5 patients,subacute onset in 1 patients,and 4 patients with chronic progression.Clinical manifestations were cognitive impairment in 8 cases,disorder of consciousness in 4 cases,psychotic symptoms in 4 cases,seizures in 4 cases,myoclonic in 4 cases,extrapyramidal symptoms in 2 cases,stroke like episodes in 1 case,headache in 2 cases,fever in 2 cases,hearing loss in 1 case.Among the 10 cases who took the thyroid function tests,hyperthyroidism in 3 cases,hypothyroidism in 3 cases,subclinical hyperthyroidism in 1 case,subclinical hypothyroidism in 3 case.The level of serum thyroid peroxidase antibody increased in 10 cases,and the serum thyroglobulin antibody increased in 3 cases.5 patients received EEG examination,4 of them showed the increment of slow waves,1 case showed the fast wave activity,and 3 of them showed abnormal epileptic discharge.All of 10 patients had examined of cranial MRI,hippocampal abnormalities in 3 cases,abnormal enhanced of leptomeninges in 1 case,multiple nodules low signal in 1 case.8 patients were treated with corticosteroids,the clinical symptoms improved significantly in 5 cases,partially improved in 3 cases,and no effect in 1 case which did not receive the treatment of corticosteroids.Conclusions: After excluding all pathologic process that may result in encephalopathy include defined autoantibodies,toxins,metabolic encephalopathies,infections,structural lesions,patients who have a non-specific encephalopathy with subclinical or overt thyroid disease,high anti-thyroid antibodies should be considered for the diagnosis of Hashimoto's Encephalopathy.This increse of TPO-Ab is indispensable to the diagnosis of Hashimoto's Encephalopathy.The ATA levels did not correlate with the clinical evolution of HE.However,the increse of TPO-Ab is indispensable to the diagnosis of Hashimoto's Encephalopathy and as suggested by many authors,ATA in HE should be seen as immune collateral phenomenon.Most of the patients have an overall favorable prognosis with the treatment of glucocorticoid therapy.