Steroid-responsive Thalamic Lesions Accompanying Microbleeds in a Case of Hashimoto's Encephalopathy with Autoantibodies Against α-enolase

Yoshitaka Yamaguchi; Manabu Wada; Haruko Tanji; Katsuro Kurokawa; Toru Kawanami; Kazuyo Tanji; Makoto Yoneda; Takeo Kato

doi:10.2169/internalmedicine.52.9373

CASE REPORTS

Steroid-responsive Thalamic Lesions Accompanying Microbleeds in a Case of Hashimoto's Encephalopathy with Autoantibodies Against α-enolase

Yoshitaka Yamaguchi, Manabu Wada, Haruko Tanji, Katsuro Kurokawa, Toru Kawanami, Kazuyo Tanji, Makoto Yoneda, Takeo Kato

Author information

Yoshitaka Yamaguchi
Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Japan
Manabu Wada
Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Japan
Haruko Tanji
Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Japan
Katsuro Kurokawa
Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Japan
Toru Kawanami
Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Japan
Kazuyo Tanji
Department of Clinical Neuroscience, Yamagata University Graduate School of Medical Science, Japan
Makoto Yoneda
Second Department of Internal Medicine (Neurology), Faculty of Medicine, University of Fukui, Japan
Takeo Kato
Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Japan

Keywords: α-enolase, antithyroid antibodies, Hashimoto's encephalopathy, microbleed, steroid-responsive encephalopathy, thalamus

JOURNAL OPEN ACCESS

2013 Volume 52 Issue 11 Pages 1249-1253

DOI https://doi.org/10.2169/internalmedicine.52.9373

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Abstract

A 67-year-old man receiving antithrombotic therapy developed rapidly progressive amnesia. T2-weighted images of brain MRI revealed hyperintense lesions in the bilateral thalami accompanied by microbleeds. Antithyroglobulin antibodies and autoantibodies against the N-terminal of α-enolase (NAE) were identified in the patient's serum; therefore, Hashimoto's encephalopathy (HE) was suspected. Although the patient's radiological findings improved following steroid therapy, his symptoms did not improve, possibly due to increased thalamic microbleeds. Because anti-NAE antibodies are possibly associated with vasculitis, HE accompanied by anti-NAE antibodies may be exacerbated by microbleeds in patients receiving antithrombotic therapy.

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