Hashimoto's encephalopathy misdiagnosed as pyogenic meningoencephalitis

Abstract

Hashimoto's encephalopathy is a controversial and underrecognized condition, associated with autoimmune thyroiditis. Presentation may be an insidious development of cognitive impairment or recurrent acute episodes of focal neurological deficit with confusion. Here, we present a case of middle-aged female that presented with headache, vomiting with alteration of sensorium, and left side weakness and responded well to steroids. A negative microbiological screen of the cerebrospinal fluid (CSF) and serum along with raised CSF protein, elevated serum antithyroid antibodies, and characteristic electroencephalogram and neuroimaging findings yielded the diagnosis.

Keywords

• Cerebrospinal fluid
• Hashimoto's encephalopathy
• nonvasculitic autoimmune meningoencephalitis
• steroid-responsive encephalopathy