ABSTRACT
RATIONALE: Hashimoto's encephalopathy (HE) is associated with autoimmune thyroid disease and is complex, diverse, and easily misdiagnosed. However, if HE is diagnosed and treated in a timely manner, an optimal prognosis may be achieved. PATIENT CONCERNS: We presented a case of a 63-year-old female patient with paroxysmal dizziness, unsteady gait, emotion apathy, progressive cognitive impairment, and unusual magnetic resonance imaging (MRI) findings. DIAGNOSES: After suffering for almost 8 years, the patient was diagnosed with HE based on clinical manifestation, abnormal electroencephalogram, unusual MRI findings, sensitivity to cortisol treatment, and characteristic high antithyroid peroxidase antibody (TpoAb) titer. INTERVENTIONS: The patient continued regular glucocorticoids therapy after intravenous methylprednisolone pulse therapy, neurotrophic drugs, traditional Chinese medicine and rehabilitation to relieve hypermyotonia and cognitive impairment. OUTCOMES: After combined treatment, the patient's symptoms, electroencephalogram (EEG), MRI, and the TpoAb titer gradually improved. However, the patient had to stop glucocorticoids treatment because of severe osteoporosis, fractures and other adverse reactions. Her symptoms fluctuated, and her TpoAb titer increased again. LESSONS: HE may cause highly heterogeneous clinical features, particularly MRI findings. Withdrawal of the systematic glucocorticoids treatment can lead to varied outcomes in these patients.
Subject(s)
Brain Diseases/complications , Encephalitis/diagnosis , Hashimoto Disease/complications , Methylprednisolone/therapeutic use , Administration, Intravenous , Autoantibodies/metabolism , Brain Diseases/diagnostic imaging , Brain Diseases/pathology , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/etiology , Dizziness/diagnosis , Dizziness/etiology , Electroencephalography , Encephalitis/complications , Encephalitis/metabolism , Encephalitis/therapy , Female , Gait Disorders, Neurologic/diagnosis , Gait Disorders, Neurologic/etiology , Glucocorticoids/administration & dosage , Glucocorticoids/adverse effects , Glucocorticoids/therapeutic use , Hashimoto Disease/diagnosis , Hashimoto Disease/metabolism , Hashimoto Disease/therapy , Humans , Magnetic Resonance Imaging , Methylprednisolone/administration & dosage , Methylprednisolone/adverse effects , Middle Aged , Pulse Therapy, Drug/methods , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
OBJECTIVE: To explore the relevant factor of cannulated compression screws in treating femoral neck fractures. METHODS: From January 2004 to January 2011, 190 patients with femoral neck fractures treated by cannulated compression screws were analyzed retrospectively. In all of the 190 cases, there were 104 males and 86 females with an average of 65 years (ranged, 21 to 83 years). According to Garden classification system, 25 cases were type I, 51 cases were type II, 58 cases were type II and 56 cases were type IV. The time from injury to operation was 15 h to 10 d (mean 3.5 d). The gender,age, trauma type, fracture type, osteoporosis, emergency operation, fracture reduction, relation between open reduction and nonunion were observed and analyzed. RESULTS: All patients were followed-up for 12 to 84 months, with a mean of 38 months. All incisions obtained stage I healing. There were 23 patients with bone nonunion. The rate of nonunion was 12.1%. Single factor analysis showed that there were significant differences in age, trauma type, fracture type, fracture reduction and osteoporosis (P<0.05), but no meaning in gender, emergency operation, relation between open reduction and nonunion (P>0.05). CONCLUSION: Cannulated compression screws for femoral neck fractures can obtain good outcomes, and age, trauma type, fracture type, fracture reduction and osteoporosis are main factors.
