Abstracts

We present a 33-year-old woman presented with a subacute confusional state, headaches, myoclonus, seizures, unsteadiness and an amnesic syndrome as a presentation of Hashimoto[apos]s encephalopathy. Complementary investigations showed euthyroidism,raised thyroid microsomal antibodies, pleocytosis in CSF, negative neuronal potassium channels, negative antineuronal antibodies, negative PCR for herpes simple virus in four determinations, continuous bitemporal spikes in EEG, normal PET study, chest CTscan and mamography. The patient was 21 days in intensive care unit with invasive ventilation and general anesthesia with unresponsive to antiepileptic drugs. A T2-weighted MRI of the brain showed bilateral symmetric areas of increased signal in the mesial temporal lobes and hippocampus that had a low signal intensity on T1-weighted imaging and gadolinium enhanced. The clinical and radiologic improvement after steroid and inmunoglobulin therapy. The patient was assessed neuropsychologically three months after discharge. Her scores on executive skills, visual, verbal, working and autobiographical memories were all pathological. Her scores on language, visuospatial, visuoconstructive functioning were all above average. Atentional process are slowed. The clinical and laboratory features in this case support a diagnosis of Hashimoto[acute]s encephalopathy. We think than the immunoglobulin treatment is a important options in those patients. We conclusions that in cases with epilepticus status and bilateral mesial temporal involvement is necessary to reject Hashimoto[apos]s encephalopathy and use precocious inmunomodulador treatment for prevent consequences. The thyroid microsomal antibodies determinations is necessary in cases with bilateral mesial temporal involvement and cryptogenic epilepticus status.[figure1]