Ogbebor Osakpolor, Patel Kavya
Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, USA.
BMJ Case Rep. 2019 Sep 6;12(9):e230118. doi: 10.1136/bcr-2019-230118.
Cognitive impairment is a frequent presentation of patients who come to the hospital. We report a case of a patient who presents with a common symptom, however, with a rare disease. This is an 84-year-old woman with a history of hypertension and atrial fibrillation who was reported to have confusion of 3 weeks. Investigations, including a complete blood count, MRI imaging of the brain, cerebrospinal fluid analysis and paraneoplastic screen, were all negative. Of note, thyroid peroxidase antibody was elevated. She did not have a history of thyroid disease. Following this, an assessment of Hashimoto encephalopathy was made. She was started on steroids and she showed remarkable recovery within 2 months, therefore, confirming the diagnosis. This case report emphasises the need to consider Hashimoto's encephalopathy as a differential for delirium especially when other common aetiologies have been ruled out.
认知障碍是前来医院就诊患者的常见症状。我们报告一例患者，其表现为常见症状，但患有罕见疾病。这是一位84岁女性，有高血压和心房颤动病史，据报告出现了3周的意识模糊。包括全血细胞计数、脑部MRI成像、脑脊液分析和副肿瘤筛查在内的检查均为阴性。值得注意的是，甲状腺过氧化物酶抗体升高。她既往无甲状腺疾病史。在此之后，对桥本脑病进行了评估。她开始使用类固醇治疗，2个月内病情显著好转，从而确诊。本病例报告强调，尤其是在排除其他常见病因后，需要将桥本脑病作为谵妄的鉴别诊断之一。
