Streaming through a case of SREAT

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Case Report

Rishav Sanghai¹  Anupam Sarkar²  Joydeep Ghosh²  Debarup Das³  Koustav Jana⁴  Kaushik Basu⁵ 

[1] Department of Emergency Medicine, Medical College and Hospital, Kolkata, India;Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education Research, Kolkata, India;Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research, Kolkata, India;Department of General Medicine, R G Kar Medical College and Hospital, Kolkata, India;Department of Neurology, Medical College and Hospital, Kolkata, India;Department of Rheumatology, Medical College and Hospital, Kolkata, India;

关键词: SREAT;    Diagnosis of exclusion;    Anti-TPO;    MRI;    Corticosteroids;   

DOI  :  10.1186/s41983-023-00669-9

 received in 2022-09-11, accepted in 2023-05-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHashimoto’s encephalopathy, also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is an autoimmune neuroendocrine disorder marked by impaired brain function. It is a diagnosis of exclusion with variable nature of presentation and no gold standard investigation of choice.Case presentationHere, we report a case of SREAT in a 26-year-old female who presented to our Emergency Department with altered sensorium and generalised tonic clonic seizures. After thorough clinical examination and initial resuscitation, a provisional diagnosis of neuroglycopenic injury or possible encephalitis was made. Broad-spectrum antibiotics were initiated. Routine investigations and cerebrospinal fluid (CSF) study were inconclusive except for neutrophilic leucocytosis. Magnetic resonance imaging (MRI) depicted hyper-intense signal changes around bilateral hippocampus and thalamus. Serum anti-thyroid peroxidase (anti-TPO) was strongly positive while other serum and CSF autoantibodies were within normal limits. A diagnosis of SREAT was made and she responded brilliantly to systemic corticosteroids. Incidentally, anti-SSA (anti-Ro) and anti-SSB (anti-La) were positive and a possible association between Sjogren’s syndrome and SREAT was insinuated.ConclusionThere is a long list of differentials for SREAT and a proper diagnostic criteria must be followed to reach at a conclusion. It can be easily missed and remain underreported due to its overlapping nature and ambiguous presentation. Hence, clinicians must have high index of suspicion for the disease and optimal therapy should be initiated early to improve the long term mortality.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

41116_2023_36_Article_IEq386.gif