Neuropediatrics 2005; 36(3): 218-220
DOI: 10.1055/s-2005-865712
Short Communication

Georg Thieme Verlag KG Stuttgart · New York

Hashimoto's Encephalopathy with Selective Involvement of the Nucleus Accumbens: A Case Report

M. M. Mancardi1 , F. Fazzini1 , A. Rossi2 , R. Gaggero1
  • 1Department of Child Neuropsychiatry, Epilepsy Unit, Giannina Gaslini Institute, Genoa, Italy
  • 2Department of Neuroradiology, Giannina Gaslini Institute, Genoa, Italy
Further Information

Publication History

Received: March 7, 2005

Accepted after Revision: May 1, 2005

Publication Date:
09 June 2005 (online)

Abstract

Hashimoto's encephalopathy (HE) is an acute or subacute relapsing disorder usually affecting euthyroid patients with evidence of autoimmune thyroiditis. The neurological manifestations are non-specific, with subacute cognitive impairment, movement disorders, generalized seizures, focal neurological symptoms such as stroke-like episodes, or psychiatric disturbances. Autoimmune phenomena are likely to play an etiological role. Magnetic resonance imaging (MRI) findings are usually normal or show non-specific changes. We report the case of an 11-year-old girl with autoimmune thyroiditis who presented acutely with a complex neuropsychiatric disorder in association with MRI evidence of focal involvement of the nucleus accumbens (NA). The NA, a ventral striate nucleus, is part of a complex dopaminergic network. Lesions to the NA result in several psychiatric symptoms, such as attention-deficit hyperactivity disorders. In this patient, we observed alternating phases of stupor and hyperkinetic-anxious behavior, with marked instability. The pathogenetic mechanism and the anatomic and functional correlations are briefly discussed.

References

  • 1 Bohnen N ILJ, Parnell K J, Harper C M. Reversible MRI findings in a patient with Hashimoto's encephalopathy.  Neurology. 1997;  49 246-247
  • 2 Brain L, Jellinek E H, Ball K. Hashimoto's disease and encephalopathy.  Lancet. 1966;  3 (2) (7462) 512-514
  • 3 Cardinal R N, Winstanley C A, Robbins T W, Everitt B J. Limbic corticostriatal systems and delayed reinforcement.  Ann N Y Acad Sci. 2004;  1021 33-50
  • 4 Chong J Y, Rowland L P, Utiger R D. Hashimoto encephalopathy.  Arch Neurol. 2003;  60 164-171
  • 5 Kothbauer-Margreiter I, Sturzenegger M, Komor J, Baumgartner R, Hess C W. Encephalopathy associated with Hashimoto thyroiditis: diagnosis and treatment.  J Neurol. 1996;  243 585-593
  • 6 Mahad D J, Staugaitis S, Ruggieri P, Parisi J, Kleinschmidt-Demasters B K, Lassmann H, Ransohoff R M. Steroid-responsive encephalopathy associated with autoimmune thyroiditis and primary CNS demyelination.  J Neurol Sci. 2005;  228 3-5
  • 7 Maydell B V, Kopp M, Komorowski G V, Joe A, Juengling F D, Korinthenberg R. Hashimoto encephalopathy: it is underdiagnosed in pediatric patients?.  Neuropediatrics. 2002;  33 86-89
  • 8 Nolte K W, Unbehaun A, Sieker H, Kloss T M, Paulus W. Hashimoto encephalopathy: a brainstem vasculitis?.  Neurology. 2000;  54 769-770
  • 9 Oide T, Tokuda T, Yazaki M, Watarai M, Mitsuhashi S, Kaneko K, Hashimoto T, Ohara S, Ikeda S. Anti-neuronal autoantibody in Hashimoto's encephalopathy: neuropathological, immunohistochemical, and biochemical analysis of two patients.  J Neurol Sci. 2004;  217 7-12
  • 10 Sellal F, Berton C, Andriantseheno M, Clerc C. Hashimoto's encephalopathy exacerbations associated with menstrual cycle.  Neurology. 2002;  59 1633-1635
  • 11 Zettinig G, Asenbaum S, Fueger B J, Hofmann A, Diemling M, Mittlboeck M, Dudczak R. Increased prevalence of subclinical brain perfusion abnormalities in patients with autoimmune thyroiditis: evidence of Hashimoto's encephalitis?.  Clin Endocrinol. 2003;  59 637-643

Dr. Roberto Gaggero

Department of Child Neuropsychiatry
Giannina Gaslini Institute

Largo G. Gaslini 5

16147 Genoa

Italy

Email: robertogaggero@ospedale-gaslini.ge.it