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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
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 4:337
Bapat N, Hingane V, Hanchnale P (2013) Hashimoto’s encephlapathy. J Indian Acad Clin Med JIACM 14(1):71–72
Bota VM, Corrigan DF (2011) Hashimoto’s encephalopathy in the setting of subclinical hypothyroidism. IJCRI 2(4):19–22
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
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):384–390
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
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)
Ferracci F, Moretto G, Candeago RM et al (2003) Antithyroid antibodies in the CSF: their role in the pathogenesis of Hashimoto’s encephalopathy. Neurology 60:712–714
Gayatri NA, Whitehouse WP (2005) Pilot survey of Hashimoto’s encephalopathy in children. Dev Med Child Neurol 47:556–558
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 5:578–581
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
Marshall GA, Doyle JJ (2006) Long-term treatment of Hashimoto’s encephalopathy. J Neuropsychiatry Clin Neurosci Winter 18(1):14–20
Nagpal T, Pande S (2004) Hashimoto’s encephalopathy: response to plasma exchange. Neurol India 52:245–247
Ray M, Kothur K, Padhy SK, Saran P (2007) Hashimoto’s encephalopathy in an adolescent boy. Indian J Pediatr 74(5):492–494
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 23:371–373
Santra G et al (2012) Hashimoto’s encephalopathy. J Assoc Physician India 60:48–50
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):172–176
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)
Vasconcellos E, Piña-Garza JE, Fakhoury T, Fenichel GM (1999) Pediatric manifestations of Hashimoto’s encephalopathy. Pediatr Neurol 20:394–398
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:e55758
Watemberg N, Greenstein D, Levine A (2006) Encephalopathy associated with Hashimoto thyroiditis: pediatric perspective. J Child Neurol 21:1–5
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)
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kutluk, M.G., Haznedar, P., Bektas, O. et al. Hashimoto’s encephalopathy in children: different manifestations of five cases. Acta Neurol Belg 119, 595–599 (2019). https://doi.org/10.1007/s13760-019-01191-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13760-019-01191-7