Abstract
We describe here a 63-year-old woman who presented with gait disturbance and micrographia. Laboratory tests demonstrated the presence of anti-thyroperoxidase (TPO) antibodies and vitamin B12 deficiency accompanied by the presence of anti-parietal cell antibodies. Lymphocytosis with increased protein was detected in cerebral spinal fluid (CSF). Serum autoantibodies against the anti-NH2 terminal of α-enolase (NAE), a specific diagnostic marker for Hashimoto’s encephalopathy (HE), were also detected. Since underlying autoimmune conditions were suspected to be associated with Hashimoto’s disease, steroid therapy was conducted, and the neurological symptoms improved a few days after the therapy was started. Attention should be given to the possibility that typical parkinsonism showing micrographia is caused by HE.
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References
Hajj-Ali RA, Calabrese LH (2009) Central nervous system vasculitis. Curr Opin Rheumatol 21:10–18
Chong JY, Rowland LP, Utiger RD (2003) Hashimoto encephalopathy: syndrome or myth? Arch Neurol 60:164–171
Fujii A, Yoneda M, Ito T et al (2005) Autoantibodies against the amino terminal of alpha-enolase are a useful diagnostic marker of Hashimoto’s encephalopathy. J Neuroimmunol 162:130–136
Brain L, Jellinek EH, Ball K (1996) Hashimoto’s disease and encephalopathy. Lancet 2:512–514
Ochi H, Horiuchi I, Araki N et al (2002) Proteomic analysis of human brain identifies alpha-enolase as a novel autoantigen in Hashimoto’s encephalopathy. FEBS Lett 528:197–202
Yoneda M, Fujii A, Ito A et al (2007) High prevalence of serum autoantibodies against the amino terminal of alpha-enolase in Hashimoto’s encephalopathy. J Neuroimmunol 185:195–200
Ness-Abramof R, Nabriski DA, Braverman LE et al (2006) Prevalence and evaluation of B12 deficiency in patients with autoimmune thyroid disease. Am J Med Sci 332:119–122
Pancholi V, Fischetti VA (1998) Alpha-enolase, a novel strong plasminogen binding protein on the surface of pathogenic streptococci. J Biol Chem 273:14503–14515
Nolte KW, Unbehaun A, Sieker H et al (2000) Hashimoto encephalopathy: a brainstem vasculitis? Neurology 54:769–770
Westman KW, Erfurth EM, Hagmar L, Bygren PG, Ericsson UB, Landin-Olsson M (1993) Increased prevalence of thyroid peroxidase antibodies (TPO-Ab) in women with glomerulonephritis. Nephrol Dial Transplant 8:402–406
Acknowledgments
The authors thank Dr. Osamu Watanabe at Kagoshimia University School of Medicine for anti-VGKC analysis and Dr. Yukitoshi Takahashi at National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders for anti-NMDR analysis.
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Inoue, K., Kitamura, J., Yoneda, M. et al. Hashimoto’s encephalopathy presenting with micrographia as a typical feature of parkinsonism. Neurol Sci 33, 395–397 (2012). https://doi.org/10.1007/s10072-011-0750-x
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DOI: https://doi.org/10.1007/s10072-011-0750-x