Sipilä Jussi O T, Rissanen Eero, Korpela Jaana, Päivärinta Markku
Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.
Department of Neurology, University of Turku, Turku, Finland.
Oxf Med Case Reports. 2018 Sep 24;2018(10):omy073. doi: 10.1093/omcr/omy073. eCollection 2018 Oct.
Being treatable, steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), or Hashimoto's encephalopathy, should be distinguished from untreatable conditions. Our patient was a previously healthy 89-year-old man, who presented with cognitive and balance deterioration over several months. His cerebrospinal fluid (CSF) examination was positive for protein 14-3-3 but no other test suggested Creutzfeldt-Jacob disease. His condition improved markedly, although not fully, with intravenous corticosteroids. In control CSF sampling, protein 14-3-3 was negative but a biomarker signature consistent with Alzheimer's disease was observed. SREAT should be considered also in the very elderly in case of subacute encephalopathy.
可治疗的自身免疫性甲状腺炎相关性类固醇反应性脑病（SREAT），即桥本脑病，应与不可治疗的疾病相区分。我们的患者是一位既往健康的89岁男性，在数月内出现认知和平衡功能恶化。他的脑脊液（CSF）检查显示14-3-3蛋白呈阳性，但没有其他检查提示克雅氏病。静脉注射皮质类固醇后，他的病情虽未完全恢复，但有明显改善。在对照CSF采样中，14-3-3蛋白呈阴性，但观察到与阿尔茨海默病一致的生物标志物特征。对于非常年老的患者出现亚急性脑病的情况，也应考虑SREAT。
