Hashimoto's encephalopathy: a frequently missed diagnosis

Hashimoto's encephalopathy is described as a syndrome of encephalopathy and high serum antithyroid antibodies that is responsive to glucocorticoid therapy. We report a patient with overt hypothyroidism who presented with stroke-like episodes and a status epilepticus which responded dramatically to intraveous methylprednisolone given for a severe bronchospasm following aspiration. The high antithyroid antibody titers and the response to steroids supported the diagnosis of Hashimoto's encephalopathy. The diagnosis of Hashimoto's encephalopathy is generally under diagnosed and often missed at presentation