Katagiri Noritaka, Ohta Ryuichi, Yamane Fumiko, Sano Chiaki
Family Medicine, Department of Community Medicine Management, Faculty of Medicine, Shimane University, Izumo, JPN.
Community Care, Unnan City Hospital, Unnan, JPN.
Cureus. 2022 Jul 31;14(7):e27518. doi: 10.7759/cureus.27518. eCollection 2022 Jul.
Autoimmune encephalitis is caused by immunological reactions showing unconsciousness, agitation, and other neurological symptoms. Autoimmune diseases can be related to autoantibodies, causing encephalitis. These autoantibody-related encephalitides could appear in various clinical courses. As laboratory tests for detecting these antibodies are limited, diagnosis is difficult. Hashimoto's encephalopathy is autoimmune encephalitis caused by antibodies against the thyroid gland. This time, we experienced a case of a 69-year-old man with a chief complaint of subacute progression of amnesia and suspected autoimmune encephalitis, who was finally diagnosed with Hashimoto's encephalopathy in a rural community hospital. In this case, clinicians should consider Hashimoto's encephalopathy as a differential diagnosis and measure antithyroid antibodies when acute or subacute onset cognitive impairment is observed in middle-aged patients. As a super-aging society significantly affects community hospitals, general physicians need to start treatments for encephalopathy and encephalitis when clinicians suspect the disease and rule out other critical diseases.
自身免疫性脑炎由免疫反应引起,表现为意识丧失、躁动及其他神经症状。自身免疫性疾病可能与自身抗体有关,进而引发脑炎。这些与自身抗体相关的脑炎可能呈现出各种临床病程。由于检测这些抗体的实验室检查有限,诊断较为困难。桥本脑病是由抗甲状腺抗体引起的自身免疫性脑炎。此次,我们接诊了一名69岁男性患者,其主要症状为记忆力减退的亚急性进展,疑似自身免疫性脑炎,最终在一家乡村社区医院被诊断为桥本脑病。在这种情况下,当在中年患者中观察到急性或亚急性起病的认知障碍时,临床医生应将桥本脑病作为鉴别诊断,并检测抗甲状腺抗体。由于超老龄化社会对社区医院影响显著,当临床医生怀疑患有脑病和脑炎并排除其他严重疾病时,全科医生需要开始进行治疗。