Dados do Trabalho

Título

ENCEFALOPATIA DE HASHIMOTO: DESAFIO DE DIAGNÓSTICO

RESUMO

Title: Hashimoto Encephalopathy: Diagnostic Challenge.
Case Presentation: Woman, 49 years old, with hypothyroidism and fibromyalgia. The first symptom reported by her husband was crisis of anxiety that in a monthwas more frequent and associated with hallucinations. In 2 months, he noticed changes in memory with temporo-spatial disorientation and difficulty in recognizing family members. Involuntary tremors in the upper limbs of myoclonus were observed more frequently during sleep. During a 9-month diagnostic investigation,the patient underwent a psychiatrist's hospital being treated as a psychotic break. She was hospitalized with the hypothesis of limbic encephalitis after neurologic evaluation. The tests revealed; MRI of the brain with alteration signal in the hippocampus bilaterally, electroencephalogram with record of electrographic crisis and presence of paroxysm in the previous temporal regions bilaterally. Serum tests identified anti-TPO:940. Markers for autoimmune encephalitis were all negative and the possibility of paraneoplastic syndrome was ruled out. Pulse therapy with methylpredinisone was performed and lamotriginewas prescribed. The patient showed significant clinical improvement.
Discussion: Hashimoto encephalopathy (HE) is a term used to describe a rare encephalopathy, of presumed autoimmune origin, associated with Hashimoto's thyroiditis. It is included in a group of nonvasculitic autoimmune inflammatory meningoencephalopathies. The patient described presented all the characteristic symptoms: behavioral and psychiatric symptoms, movement disorders and convulsions. The way symptoms are on set up is typically acute or subacute which can become chronic.
Final Comments: Behavioral complaints, hallucinations, accompanied by memory deficits and language disorders, are often found at an early stage of HE and may be confused with psychiatric disorders. Common differential diagnoses should be made with Creutzfeldt-Jakob disease, rapidly progressive dementias and limbic encephalitis.

Palavras Chave

ENCEFALOPATIA
ENCEFALOPATIA DE HASHIMOTO
DESAFIO DIAGNÓSTICO