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.

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Dr. Roberto Gaggero

Department of Child Neuropsychiatry
Giannina Gaslini Institute

Largo G. Gaslini 5

16147 Genoa

Italy

Email: robertogaggero@ospedale-gaslini.ge.it

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