Hashimotos encephalitis: role of diagnostic SPECT
Tomas Martin, Alfonso Gentil, Alberto Torres, Silvia Maraver & Milagrosa Diaz-Galvez
In autoimmune thyroid disease some diverse neurological alterations like dementia, psychosis or peripheral neuropathy, are described. Hashimotos encephalopathy (EH) is a serious form of these neurological alterations. We describe three cases with different presentation and morphologic normal tests where cerebral SPECT was diagnostic.
Case n°1. A 32-year-old male diagnosed of autoimmune hypothyroidism which presents paresthetics and muscular stiffening, what do not improve with oral levotiroxine. The analyses shows a TSH> 200 and T4L of 0.2 ng/dl, with Ac. antiTPO> 4500 U/ml. After substitution, TSH 9, T4 l 1.80 ng/dl. RMN cranial and EEG were no diagnostic, SPECT shows cortical diffuse hypoperfusión, starting therapy with deflazacort 60 mg/24 h with evident improvement, worsening when the was reduced. Treatment was restored by 2 mg/kg. with resolution of the clinic.
Case n°2. 39-year-old female presents migraine, confusion and agitation with hallucinations and fever treated with aciclovir and antibiotics. A normal thyroid function with Ac. antiTPO >3000 U/ml was found and SPECT show patched cortical affectation in temporal lobe. Therapy with prednisona to 1.5 mg/kg was established, with successful results.
Case n°3. 33-year-old male with hiperthyroidisim autoimmune, in treatment with carbimazole, present a convulsive stroke. Increase TSI (TSI> 40 U/ml) and Ac antiTPO: 5850 U/ml, with normal thyroid function was found (TSH: 0,025 mU/ml, T4L 1,90 ng/dl). A treatment with carbamazepine (800 mg/24 h), discharging him. One month later he shows recidivants convulsive attacks again. Normal RMN, slow wave diffuse EEG without epileptic foci. SPECT showed a decrease of cortical perfusión. Therapy with steroids achieved disapparing the convulsions.
Conclusions: EHs diagnosis must be considered in subacute presentation, high levels of antithyroid antibodies (even with thyroid normal function) and absence of another pathology. The practice of cerebral SPECT a and a fast response to steroids are important confirmation signs in this pathology.