Advertisement

Acta Neurologica Belgica

, Volume 119, Issue 4, pp 595–599 | Cite as

Hashimoto’s encephalopathy in children: different manifestations of five cases

  • Muhammet Gultekin KutlukEmail author
  • Pınar Haznedar
  • Omer Bektas
  • Naz Kadem
  • Gokcen Oz Tuncer
  • Pelin Albayrak
  • Serap Teber
Original article
  • 40 Downloads

Abstract

Hashimoto’s encephalopathy (HE) is a rare, poorly understood, progressive and relapsing, steroid-responsive multiform disease. HE presents with subacute cognitive dysfunction, psychiatric symptoms, seizures, and movement disorders. The disorder is usually related to thyroid disease and the most frequent feature is the presence of anti-thyroperoxidase antibodies. Patients are generally euthyroid or mildly hypothyroid. The clinical features of two patients at presentation included refractory seizures and confusion, another patient had behavioral problems and altered cognitive status, one patient presented with right-sided weakness and numbness especially in his leg and tongue, dysphagia, speech disorder, aggressiveness, nightmares and nocturnal enuresis and last patient had focal seizures with altered mental status. All patients manifested increased anti-thyroid antibodies. Four patients improved with steroid treatment, and one of the patients responded to plasmapheresis instead of corticosteroid treatment. Physicians’ awareness of this complication is of great importance because HE is a highly treatable condition among children and adolescents.

Keywords

Hashimoto’s encephalopathy (HE) Seizures Psychosis 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain studies with human or animals performed by any of the authors.

References

  1. 1.
    Aybar CC, Loja-Oropeza D, Cuadra-Urtega J, Romani-Romani F (2010) Hashimoto’s encephalopathy presenting with neurocognitive symptoms: a case report. J Med Case Rep 4:337CrossRefGoogle Scholar
  2. 2.
    Bapat N, Hingane V, Hanchnale P (2013) Hashimoto’s encephlapathy. J Indian Acad Clin Med JIACM 14(1):71–72Google Scholar
  3. 3.
    Bota VM, Corrigan DF (2011) Hashimoto’s encephalopathy in the setting of subclinical hypothyroidism. IJCRI 2(4):19–22CrossRefGoogle Scholar
  4. 4.
    Chong JY, Rowland LP, Utiger RD (2003) Hashimoto encephalopathy syndrome or myth? Arch Neurol 60(2):164–171.  https://doi.org/10.1001/archneur.60.2.164 CrossRefPubMedGoogle Scholar
  5. 5.
    de Holanda NCP, de Lima DD, Cavalcanti TB, Lucena CS, Bandeira F (2011) Hashimoto’s encephalopathy: systematic review of the literature and an additional case. J Neuropsychiatry Clin Neurosci 23(4):384–390CrossRefGoogle Scholar
  6. 6.
    Dham BS, Hunter K, Rincon F (2014) The epidemiology of status epilepticus in the United States. Neurocritical Care 20(3):476–483.  https://doi.org/10.1007/s12028-013-9935-x CrossRefPubMedGoogle Scholar
  7. 7.
    Doe De Maindreville A, Gombert C, Thiriaux A, Chaunu M, Bakchine S (2013) Hashimoto’s encephalopathy: a rare cause of status epilepticus. Rev Neurol (Paris) 169(4):345–349.  https://doi.org/10.1016/j.neurol.2012.10.014(Epub 2013 Feb 260) CrossRefGoogle Scholar
  8. 8.
    Ferracci F, Moretto G, Candeago RM et al (2003) Antithyroid antibodies in the CSF: their role in the pathogenesis of Hashimoto’s encephalopathy. Neurology 60:712–714CrossRefGoogle Scholar
  9. 9.
    Gayatri NA, Whitehouse WP (2005) Pilot survey of Hashimoto’s encephalopathy in children. Dev Med Child Neurol 47:556–558CrossRefGoogle Scholar
  10. 10.
    Janes SE, Santosh B, Thomas D, Vyas H (2004) Hashimoto’s encephalopathy: an unusual cause of seizures in the intensive care unit. Pediatr Crit Care Med 5:578–581CrossRefGoogle Scholar
  11. 11.
    Lee M-J, Lee H-S, Hwang J-S, Jung D-E (2012) A case of Hashimoto’s encephalopathy presenting with seizures and psychosis. Korean J Pediatr 55(3):111–113.  https://doi.org/10.3345/kjp.2012.55.3.111 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Marshall GA, Doyle JJ (2006) Long-term treatment of Hashimoto’s encephalopathy. J Neuropsychiatry Clin Neurosci Winter 18(1):14–20CrossRefGoogle Scholar
  13. 13.
    Nagpal T, Pande S (2004) Hashimoto’s encephalopathy: response to plasma exchange. Neurol India 52:245–247PubMedGoogle Scholar
  14. 14.
    Ray M, Kothur K, Padhy SK, Saran P (2007) Hashimoto’s encephalopathy in an adolescent boy. Indian J Pediatr 74(5):492–494CrossRefGoogle Scholar
  15. 15.
    Rodrigez A, Jicha G, Steeves T, Benarroch E, Westmoreland B (2006) EEG changes in a patient with steroid responsive encephalopathy associated with antibodies to thyroperoxidase (SREAT, Hashimoto’s encephalopathy). J Clin Neurophysiol 23:371–373CrossRefGoogle Scholar
  16. 16.
    Santra G et al (2012) Hashimoto’s encephalopathy. J Assoc Physician India 60:48–50Google Scholar
  17. 17.
    Seipelt M, Zerr I, Nau R, Mollenhauer B, Kropp S, Steinhoff BJ (1999) Hashimoto’s encephalitis as a differential diagnosis of Creutzfeldt–Jakob disease. J Neurol Neurosurg Psychiatry 66(2):172–176CrossRefGoogle Scholar
  18. 18.
    Striano P, Pagliuca M, Andreone V, Zara F, Coppola A, Striano S (2006) Unfavourable outcome of Hashimoto encephalopathy due to status epilepticus. One autopsy case. J Neurol 253(2):248–249 (Epub 2005 Nov 22) CrossRefGoogle Scholar
  19. 19.
    Vasconcellos E, Piña-Garza JE, Fakhoury T, Fenichel GM (1999) Pediatric manifestations of Hashimoto’s encephalopathy. Pediatr Neurol 20:394–398CrossRefGoogle Scholar
  20. 20.
    Wang J, Zhang J, Xu L, Shi Y, Wu X, Guo Q (2013) Cognitiveimpairments in Hashimoto’s encephalopathy: a case-control study. PLoS One 8:e55758CrossRefGoogle Scholar
  21. 21.
    Watemberg N, Greenstein D, Levine A (2006) Encephalopathy associated with Hashimoto thyroiditis: pediatric perspective. J Child Neurol 21:1–5CrossRefGoogle Scholar
  22. 22.
    Zhou JY, Xu B, Lopes J, Blamoun J, Li L (2017) Hashimoto encephalopathy: literature review. Acta Neurol Scand 135(3):285–290.  https://doi.org/10.1111/ane.12618(Epub 2016 Jun 20) CrossRefPubMedGoogle Scholar

Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  1. 1.Division of Child NeurologyAntalya Training and Research HospitalAntalyaTurkey
  2. 2.Division of Child Neurology, Department of Pediatrics, School of MedicineAnkara UniversityAnkaraTurkey
  3. 3.Department of PediatricsAntalya Training and Research HospitalAntalyaTurkey

Personalised recommendations