Serial Changes in Diffusion-Weighted Magnetic Resonance Images with Hypoperfusion on Brain SPECT in a Case of Hashimoto’s Encephalopathy: Understanding Pathophysiology of Hashimoto’s Encephalopathy
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Diffuse or focal white matter hyperintensity lesions on MRI have been reported in only a few patients with Hashimoto’s encephalopathy (HE), and anti-TPO antibody level is high in most cases. We report a 59-year-old woman who presented with acute onset of disorientation with confusion. Anti-thyroglobulin antibody was detected in high titer, although anti-TPO antibody titer was not high. Thyroid sonography and biopsy revealed Hashimoto’s thyroiditis. Initial fluid-attenuated inversion recovery (FLAIR) image and diffusion-weighted imaging (DWI) revealed ill-defined, diffuse, high-signal intensity lesions on the deep white matters and globus pallidus. Brain SPECT showed significant hypoperfusion in both basal ganglia (especially globus pallidus), frontal and temporal lobes. With the impression of HE, the patient was treated on a high-dose steroid. Over the next 15 weeks, her cognition improved to a nearly normal state and the MRI findings on DWI and FLAIR showed resolution paralleling her clinical improvement. Our case illustrates the peculiar changes in the MR findings, especially in DWI, with hypoperfusion on brain SPECT in patients with HE and allows for a greater understanding of the pathophysiology of HE.
Abstract
Diffuse or focal white matter hyperintensity lesions on MRI have been reported in only a few patients with Hashimoto’s encephalopathy (HE), and anti-TPO antibody level is high in most cases. We report a 59-year-old woman who presented with acute onset of disorientation with confusion. Anti-thyroglobulin antibody was detected in high titer, although anti-TPO antibody titer was not high. Thyroid sonography and biopsy revealed Hashimoto’s thyroiditis. Initial fluid-attenuated inversion recovery (FLAIR) image and diffusion-weighted imaging (DWI) revealed ill-defined, diffuse, high-signal intensity lesions on the deep white matters and globus pallidus. Brain SPECT showed significant hypoperfusion in both basal ganglia (especially globus pallidus), frontal and temporal lobes. With the impression of HE, the patient was treated on a high-dose steroid. Over the next 15 weeks, her cognition improved to a nearly normal state and the MRI findings on DWI and FLAIR showed resolution paralleling her clinical improvement. Our case illustrates the peculiar changes in the MR findings, especially in DWI, with hypoperfusion on brain SPECT in patients with HE and allows for a greater understanding of the pathophysiology of HE.
참고문헌 (9)
- Nicoline Schiess, "Pardoa. Hashimoto’s Encephalopathy", Ann NY Acad Sci, 1142, pp.254~265 (2008)
- Ferracci F, "Anti-thyroid antibodies in the CSF: their role in the pathogenesis of Hashimoto’s encephalopathy", Neurology, 60, pp.712~714 (2003)
- Grommes C, "Steroid-responsive encephalopathy associated with autoimmune thyroiditis presenting with diffusion MR imaging changes", AJNR Am J Neuroradiol, 29, pp.1550~1551 (2008)
- Chen C, "Time course of Hashimoto’s encephalopathy revealed by MRI: Report of two cases", J Neurol Sci, 300, pp.169~172 (2011)
- Mijajlovic M, "Clinical manifestations, diagnostic criteria and therapy of Hashimoto’s encephalopathy: report of two cases", J Neurol Sci, 288, pp.194~196 (2010)
- Blanchin S, "Anti-thyroperoxidase antibodies from patients with Hashimoto’s encephalopathy bind to cerebellar astrocytes", J Neuroimmunol, 192, pp.13~20 (2007)
- Kothbauer-Margreiter I, "Encephalopathy associated with Hashimoto thyroiditis: diagnosis and treatment", J Neurol, 243, pp.585~593 (1996)
- Chang T, "Hashimoto encephalopathy: clinical and MRI improvement following high-dose corticosteroid therapy", Neurologist, 16, pp.394~396 (2010)
- Forchetti CM, "Autoimmune thyroiditis and a rapidly progressive dementia: global hypoperfusion on SPECT scanning suggests a possible mechanism", Neurology, 49, pp.623~626 (1997)