Ishii K, Hayashi A, Tamaoka A, Mizusawa H, Shoji S
Department of Neurology, University of Tsukuba.
Rinsho Shinkeigaku. 1993 Sep;33(9):995-7.
A case of 43-year-old woman with Hashimoto's encephalopathy who experienced three relapses closely associated with the menstrual cycle is reported. In April 1992, she began to experience occasional tremors in her arms. Three months later, she experienced a generalized seizure and was transferred to our hospital. Hashimoto's thyroiditis was diagnosed on the basis of high thyroid microsomal titer and mild hypothyroidism. Neurological findings in admission included action tremor in both hands, myoclonus in all extremities, cerebellar ataxia, confusion, and hyperreflexia. Cerebrospinal fluid showed elevated protein level without pleocytosis. Electroencephalogram showed diffuse slowing and magnetic resonance imaging of brain was normal. Hashimoto's encephalopathy was diagnosed from these findings. These episodes of remission and exacerbation were observed during the admission. Her symptoms started at ovulation, worsened during the luteal phase, and improved when menstruation started. After the third relapse, she was treated with oral thyroxine for hypothyroidism and with an estrogen and progesterone combination to regulate the menstrual cycle. Her thyroid function gradually became euthyroid and she did not experience any subsequent relapses. The relation between the relapsing course and menstrual cycle suggests that the periodic alteration of gonadotrophic and/or gonadal hormones or the menstrual regulating center itself in the brain may be an important factor of pathogenetic mechanism of the disorder.
报告了一例43岁患有桥本脑病的女性患者，其经历了三次与月经周期密切相关的复发。1992年4月，她开始偶尔感到手臂震颤。三个月后，她发生了一次全身性癫痫发作，随后被转至我院。根据高甲状腺微粒体滴度和轻度甲状腺功能减退症诊断为桥本甲状腺炎。入院时的神经学检查发现包括双手动作性震颤、四肢肌阵挛、小脑共济失调、意识模糊和反射亢进。脑脊液显示蛋白水平升高但无细胞增多。脑电图显示弥漫性减慢，脑部磁共振成像正常。根据这些发现诊断为桥本脑病。在住院期间观察到了缓解和加重的发作。她的症状在排卵时开始，在黄体期加重，月经开始时改善。第三次复发后，她接受了口服甲状腺素治疗甲状腺功能减退症，并使用雌激素和孕激素联合治疗来调节月经周期。她的甲状腺功能逐渐恢复正常，此后未再复发。复发过程与月经周期之间的关系表明，促性腺激素和/或性腺激素的周期性变化或大脑中的月经调节中心本身可能是该疾病发病机制的一个重要因素。
