Ann Clin Neurophysiol.  2020 Apr;22(1):24-28. 10.14253/acn.2020.22.1.24.

Febrile Hashimoto’s encephalopathymimicking infectious encephalitis

• Lee JJ
• Youn MS
• Park JM
• Kwon O
• Lee WW
• Kang K
• Kim BK

• KMID: 2500300
• DOI: http://doi.org/10.14253/acn.2020.22.1.24

Abstract

Hashimoto’s encephalopathy (HE) is a heterogeneous encephalopathy with diverse clinical presentations. Here we report on a 69-year-old woman who presented with confusion, aphasia, fever, and focal ictal discharges. Cerebrospinal fluid analysis and a workup for other fever origins revealed no abnormality and a high level of thyroperoxidase antibody was detected, which findings led to a diagnosis of HE. The symptoms subsided after treatment. This study highlights the importance of considering HE in patients presenting with fever and abnormal EEG findings.

Keyword

Electroencephalography; Encephalopathy; Fever

Figure

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  Fig. 1. Brain fluid-attenuated inversion recovery magnetic resonance imaging (MRI) (A, B) and diffusion-weighted MRI (C, D) showing no abnormalities in the left frontotemporal area.

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  Fig. 2. Initial electroencephalography findings showing intermittent rhythmic and quasi-rhythmic slow waves in the left frontotemporal area with fluctuating amplitude and frequency. EKG, electrocardiography.

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  Fig. 3. Follow-up electroencephalography (EEG) performed at 4 hours after the initial EEG showing that the asymmetric rhythmic and quasi-rhythmic discharges observed in the initial EEG had nearly disappeared. EKG, electrocardiogram.

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