BMJ Case Reports 2017; doi:10.1136/bcr-2017-219933
  • Rare disease

Focal neurological presentation in Hashimoto's encephalopathy mimicking a vascular occlusion of the middle cerebral artery

  1. Alan N. Peiris3
  1. 1Department of Internal Medicine, Whitesburg ARH Hospital, Whitesburg, Kentucky, USA
  2. 2School of Medicine , Texas Technical University Health Sciences Center , Lubbock, Texas, US
  3. 3Clinical Research Institute and Department of Internal Medicine, Texas Technical University Health Sciences Center, Lubbock, Texas, USA
  1. Correspondence to Dr Ahmad Alazzeh, a.l.alazzeh{at}
  • Accepted 8 June 2017
  • Published 14 July 2017


Hashimoto’s encephalopathy is a rare form of autoimmune encephalopathy. It is likely an underdiagnosed entity especially in the setting of focal neurological defects. We report a case of a 49-year-old man who presented with “strange behavior”of a day’s duration. Examination was significant only for lethargy, poor attention span and agitation. Routine labs revealed leucocytosis. Head CT scan was unremarkable. Lumbar puncture showed high white blood cells with lymphocytosis and elevated protein level. The patient was empirically treated for meningitis without improvement. His symptoms progressed to sudden right-sided weakness, ataxia and right facial droop. The MRI and magnetic resonance angiogram (MRA)were normal. The patient’s focal neurological signs improved spontaneously. Encephalopathy work-up was negative except for positive anti-Thyroid Peroxidaseand antithyroglobulin. The patient was treated as Hashimoto encephalopathy with steroids and azathioprine with marked improvement. Our case highlights how focal neurological findings can potentially mislead the provider to consider vascular aetiologies in Hashimoto’s encephalopathy.


  • Contributors All authors contributed extensively to the work presented in this paper. AA did the planning and acquisition of date. SJ did the literature review for similar case and organised the information in table 1. MG interviewed the patient and explained the consent form and got the patient to sign it. AP did the interpretation of the data and reviewed the case for language, technical and medical errors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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