J Neurocrit Care.  2018 Jun;11(1):54-57. 10.18700/jnc.180055.

Hashimoto's Encephalopathy with Reversible Diffuse Leukoencephalopathy

• Hwang W
• Jeong DE

• KMID: 2426215
• DOI: http://doi.org/10.18700/jnc.180055

Abstract

BACKGROUND
The magnetic resonance imaging (MRI) findings of Hashimoto's encephalopathy (HE) are variable; images range from having a normal appearance, to showing ischemic lesions, demyelination, or vasogenic edema.
CASE REPORT
A 57-year-old woman presented with a sudden onset of dysarthria and dizziness. Routine blood tests were normal and the MRI was unremarkable. After admission, she developed aphasic seizures and myoclonus, and eventually became comatose. A follow up MRI showed diffuse high signal intensities at the bilateral cerebral white matter on fluid attenuated inversion recovery imaging. The serum titers of the anti-thyroglobulin antibody and anti-thyroperoxidase antibody were increased. After 5 days of 1,000 mg/day of intravenous methylprednisolone infusion, she recovered rapidly.
CONCLUSION
We propose that repeated brain MRIs are necessary for the diagnosis of HE. Diffuse leukoencephalopathy may be a pathologic finding on MRI and, in this case study, was shown to be reversible after applying an appropriate treatment.

Keyword

Hashimoto's disease; Leukoencephalopathies; Magnetic resonance imaging

MeSH Terms

Brain
Brain Diseases*
Coma
Demyelinating Diseases
Diagnosis
Dizziness
Dysarthria
Edema
Female
Follow-Up Studies
Hashimoto Disease
Hematologic Tests
Humans
Leukoencephalopathies*
Magnetic Resonance Imaging
Methylprednisolone
Middle Aged
Myoclonus
Seizures
White Matter
Methylprednisolone

Figure

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  Figure 1. Brain MRI on day 13 (A-C) and four months after presentation (D-F). Axial DWI (A), ADC mapping (B) and FLAIR (C) images showing diffuse confluent high signal intensities on the bilateral cerebral white matter. Follow-up MRI (D-F) showing the disappearance of the previous abnormal signal intensities. MRI, magnetic resonance imaging; DWI, diffusion-weighted imaging; ADC, apparent diffusion coefficient; FLAIR, fluid-attenuated inversion recovery.

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