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L’encéphalopathie d’Hashimoto en réanimation : quand doit-on l’évoquer ?

Hashimoto encephalopathy in the intensive care unit: do not miss it!

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Réanimation

Résumé

L’encéphalopathie d’Hashimoto est une affection rare qui prédomine chez la femme. Son grand polymorphisme clinique rend le diagnostic difficile, à l’origine d’une errance médicale. Les manifestations cliniques sont principalement neuropsychiatriques. Les éléments en faveur du diagnostic sont la présence d’anticorps antithyroïdiens antipéroxydase et une imagerie cérébrale normale ou peu contributivemais nécessaire pour écarter les autres diagnostics différentiels. Le diagnostic peut être évoqué après élimination des causes habituelles d’encéphalopathie, toxiques, infectieuses, vasculaires et métaboliques et devant la bonne réponse à un traitement par corticothérapie. Le médecin réanimateur doit évoquer l’encéphalopathie d’Hashimoto devant un tableau de convulsions ou d’état de mal épileptique sans cause retrouvée et débuter une corticothérapie en urgence car le traitement antiépileptique seul ne suffit pas pour en contrôler la symptomatologie épileptique.

Abstract

Hashimoto’s encephalopathy (HE) is a rare clinical entity, mostly observed in women. HE associates neuropsychiatric manifestations, elevated serum concentration of antithyroid antibodies, and responsiveness to glucocorticoid therapy. Diagnosis is frequently delayed due to the lack of specific neurological symptoms. It is frequently assessed in the intensive care unit (ICU) once the disease has progressed to a life-threatening neurological condition. HE suspicion in an ICU patient should be raised in the presence of coma, seizures or status epilepticus requiring mechanical ventilation. Corticosteroids should be promptly started, generally resulting in clinical improvement over days or weeks.

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  1. Service de réanimation médicale, CHU Bretonneau, 2 boulevard Tonnellé, F-37044, Tours cedex 9, France

    E. Mercier

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  1. E. Mercier
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Mercier, E. L’encéphalopathie d’Hashimoto en réanimation : quand doit-on l’évoquer ?. Réanimation 22, 642–647 (2013). https://doi.org/10.1007/s13546-013-0729-4

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  • DOI: https://doi.org/10.1007/s13546-013-0729-4

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