HASHIMOTO ENCEPHALOPATHY - ETIOLOGIC CONSIDERATIONS

A 15-year-old girl is described with encephalopathy associated with Ha shimoto thyroiditis which subsequently developed into autoimmune thyro toxicosis (hashitoxicosis) and distal renal tubular acidosis at age 5 years, pernicious anemia at age 9, and encephalopathy at age 12. Thyro id hormone levels were within the normal ranges at the time of neurolo gic presentation, Serum IgG concentration and oligoclonal IgG bands in cerebrospinal fluid closely correlated with the severity of neurologi c symptoms. Treatment with glucocorticoids improved the level of consc iousness but her mental state continued to deteriorate. Repeated crani al computed tomographic scans revealed progressive symmetric atrophy i n the gray matter without infarction. These findings suggest that ence phalopathy associated with Hashimoto thyroiditis is caused by an antin euronal antibody-mediated reaction.