Bonnet Udo, Selle Claudia, Kuhlmann Ralf
Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany.
Department of Neurology, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany.
Case Rep Psychiatry. 2016;2016:4168050. doi: 10.1155/2016/4168050. Epub 2016 Sep 1.
We report the case study of a 57-year-old Caucasian female with steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), commonly termed Hashimoto encephalopathy (HE). This presentation includes one of the longest lasting follow-up studies of HE considering the neuropsychiatric symptoms (here delirium, mania, and EEG-slowing) and their relation to serum autoantibody levels. Antithyroid-peroxidase autoantibodies, the hallmark of autoimmune thyroiditis, were found in the serum and also in the cerebrospinal fluid. Diagnostic analyses found no evidence of limbic encephalopathies characterized by serum antibodies against intracellular, synaptic, or further cell surface antigenic targets, neoplasm, and connective tissue or vasculitis diseases. A potential contribution of bipolar disorder and metabolic encephalopathies due to severe hypothyroidism, glucocorticoid treatment, accelerated thyroid hormone replacement therapy, or vitamin B deficiency is critically discussed. Another special feature of this case report is the linkage of HE to an autoimmune polyendocrine syndrome (type 3B) affecting the gastroduodenum in addition to the thyroid gland.
我们报告了一例57岁的白种女性病例，其患有与自身免疫性甲状腺炎相关的类固醇反应性脑病（SREAT），通常称为桥本脑病（HE）。考虑到神经精神症状（此处为谵妄、躁狂和脑电图减慢）及其与血清自身抗体水平的关系，本病例报告是对HE进行的持续时间最长的随访研究之一。血清及脑脊液中均发现了抗甲状腺过氧化物酶自身抗体，这是自身免疫性甲状腺炎的标志。诊断分析未发现以针对细胞内、突触或其他细胞表面抗原靶点的血清抗体、肿瘤以及结缔组织或血管炎疾病为特征的边缘性脑病的证据。文中对双相情感障碍以及由严重甲状腺功能减退、糖皮质激素治疗、加速甲状腺激素替代治疗或维生素B缺乏引起的代谢性脑病的潜在作用进行了批判性讨论。本病例报告的另一个特点是，HE与一种除甲状腺外还累及胃十二指肠的自身免疫性多内分泌综合征（3B型）相关。
