Table 1.

Focal neurological presentations in Hashimoto’s encephalopathy

Article	Author/year	Age/gender	Presenting focal neurological deficit	Disease course	CT or MRI findings	Response to steroids/alternate treatment
Autoimmune thyroid encephalopathy presenting with epilepsia partialis continua	Aydin-Ozemir et al/20064	37/F	Multifocal motor seizures	Asymmetrical quadriparesis, truncal ataxia and continuous semirhythmical jerks	Pathological signal alterations detected in both precentral cortices	Seizures stopped
Alternating hemiplegia of childhood or Hashimoto’s encephalopathy?	Balestri et al/19995	14/M	Aphasia lasting 5 hours	Three separate alternating hemiplegic episodes lasting 8–10 hours	Mild reduction of volume of the left nucleus caudatus	Treated with flunarizine with no clinical relapses
Unusual presentation of Hashimoto’s encephalopathy: trigeminal neuralgiform headache, skew deviation, hypomania	Beckmann et al/20116	51/M	Right medial rectus muscle palsy lasting 5 days	Left haemiparesis and skew deviation presenting 3 months later	Hyperintense lesions on right midbrain and bilateral thalamus	Initially recovered spontaneously over 5 days, treated for relapse and improved with minimal vertical gaze palsy
Hashimoto’s thyroiditis — a rare but treatable cause of encephalopathy in children	Byrne et al/20007	14/F	Generalised tonic and clonic seizure	Acute hemiplegia and aphasia	Normal	Full recovery over 72 hours within ongoing neuropsychological difficulties (one relapse treated)
		12/F	Generalised tonic and clonic seizure	Right-sided facial weakness, mild right haemiparesis, significant expressive dysphagia	Normal	Improvement after a week with persistent subtle right-sided weakness (one relapse treated)
A case of Hashimoto’s encephalopathy: association with sensory ganglionopathy	Cao et al/20058	54/F	Left-sided clumsiness lasting 20 min and transient left-sided numbness	Abnormalities in sensory nerve conduction	Mild non-specific pattern of diffusely increased signal intensity within the periventricular white matter bilaterally	Dramatic improvement within 2 days (two future relapses treated)
Time course of Hashimoto’s encephalopathy revealed by MRI: report of two cases	Chen et al/20119	27/M	Sudden weakness of both lower limbs	He was experiencing memory loss and seizures that continued to get progressively worse with time	Oval ischaemic lesion at middle splenium of corpus callosum, pre-existing lesion in right hippocampus	Symptoms of lower limb weakness relieved within 5 days, no other clinical symptoms showed improvement
Hashimoto’s encephalopathy presenting with stroke-like episodes in an adolescent female: a case report and literature review	Graham et al/201610	15/F	Sudden-onset right haemiparesis and slurred speech resolved within 35 min	Acute bilateral lower extremity weakness 2 weeks later	Normal	No further stroke-like episodes after initiation of steroids, normal neuropsychological functioning by 4 months
Seizures, psychosis and coma: severe course of Hashimoto encephalopathy in a 6 year old girl	Hoffmann et al/200711	6/F	Generalised seizure	Haemiparesis	Normal	Dramatic improvement within a day after therapy was initiated with later occasional focal seizures
Central nervous system lymphoma in a patient with Sjogren’s syndrome and autoimmune thyroiditis	Kinikli et al/200712	60/F	Muscle weakness, sudden visual loss on right eye 3 months before admission, presented with minimal paresis of left side	Development of visual loss in left eye	Hyperintense areas of right temporal basal white matter and brainstem	No improvement in right eye vision, still bedridden after therapy with developing visual loss of left eye
Subacute cerebellar syndrome or Hashimoto’s thyroiditis. Association or simple coincidence?	Mouzak et al/200213	47/F	Left leg weakness	Ataxia, dysarthria, paraplegia	Non-contrast enhancing long-standing lesion in left lateral medullary area and mild cerebellar atrophy	Slight improvement after given human normal immunoglobulin for 6 days, further improvement after steroids added to treatment plan 3 months later
Autoimmune thyroiditis and acquired demyelinating polyradiculoneuropathy	Polizzi et al/200114	7.5/F	Flaccid paraplegia	Did not develop any other neurological symptoms	Normal	Gradually improved with intravenous immunoglobulin, no motor or sensory defects on follow-up
		70/F	Unsteady gait, bilateral ophthalmoplegia, pain and paraesthesia in upper and lower extremities	Did not develop any other neurological symptom	Normal	Improved with intravenous immunoglobulins, complete remission after weeks
Rarity of encephalopathy associated with autoimmune thyroiditis	Sawka et al/200215	58/M	Unilateral weakness	Ataxia, aphasia, grand mal seizure	Diffuse white matter changes	Dramatic improvement (four relapses treated)
		63/F	Unilateral weakness	Ataxia, tremor, grand mal seizure	Normal	Improved (final relapse treated)
Ataxia associated with Hashimoto’s disease: progressive non-familial adult onset cerebellar degeneration with autoimmune thyroiditis	Selim and Drachman/200016	46/F	Diplopia, dysarthria and dysmetria of all limbs	Progressively deteriorated and became wheelchair users in the next 8 months	Diffuse cerebellar atrophy	Able to ambulate with walker after intravenous immunoglobulins, no improvement in cerebellar deficits or neurological exam
MR Findings in Hashimoto’s encephalopathy	Song et al/200417	35/F	Transient weakness of left arm	Development of left-sided clumsiness and eventual wheelchair-bound status	Left hippocampal mass and right medullary lesions, unilateral cerebellar atrophy	Marked improvement after several weeks of treatment, can ambulate without assistance
Hashimoto encephalopathy: a case report with proton MR spectroscopic findings	Su et al/201118	52/F	Disorientation, amnesia	Numbness in the right hand, blurred vision in the right eye and tonic-clonic seizures	Multiple patchy abnormal hyperintensities in bilateral cerebral hemispheres	Improved after 9 days, relapsed intermittently, follow-up MRI showed remarkable residual cerebral atrophy
A case of autoimmune thyroid disease presenting posterior reversible encephalopathy syndrome	Tateishi et al/200819	40/F	Transient loss of sensation in right arm and face 2 months before admission	Incomplete right haemiparesis lasting 2 days	Normal CT, diffusion-weighted imaging showed patchy hyperintense lesions in left occipitotemporal grey and white matter	Lesions disappeared completely after 11 days, given mercaptomethylimidazole and sensory disturbance of right arm resolved within 30 days
Rapid progression and brain atrophy in anti-AMPA receptor encephalitis	Wei et al/201320	30/F	Short-term memory impairment	Quadriparesis and quadriplegia	Hyperintensity bilaterally in insula, mesial temporal lobe and caudate nucleus with follow-up 5 days later showing bilateral diffuse cortical atrophy	Spontaneous movement of all limbs 8 weeks following onset, regained consciousness 4 months after onset, persistent irritable mood and impaired learning
Two patients with Hashimoto’s encephalopathy and uncontrolled diabetes successfully treated with levetiracetam	Wong et al/201521	56/F	Subacute aphasia and unilateral leg weakness	Did not develop any other neurological symptoms	Normal	Steroids contraindicated, given levetiracetam and returned to baseline at 6 months with mild cognitive slowing
Steroid-responsive encephalopathy associated with Hashimoto thyroiditis	Zimmermann and Stranzinger/201222	11/F	Sudden sensory disturbance and left-sided weakness	___	Hyperintensity in right lateral thalamus and internal capsule	Symptoms resolved after 5 days, persistent small hyperintense lesion in right thalamus interpreted as gliosis