A Case of Steroid-Responsive Encephalopathy.

Hashimoto's encephalopathy (HE), also known as steroid-responsive encephalopathy, is associated with autoimmune-mediated thyroiditis. Onset is typically gradual often with evolution over the course of months. Characteristic symptoms include impaired concentration and memory, delusions, hallucinations, personality changes, incoordination, tremor, hemiparesis, seizures, and speech difficulties. Diagnosis is predicated upon discovery of elevated anti-thyroid antibodies, specifically anti-thyroid peroxidase (TPO) or anti-M antibodies. Some patients may also present with subclinical hypothyroidism but many are euthyroid. Of note, neither thyroid function tests or antibody titers correlate with disease severity. Other common laboratory findings include elevations in sedimentation rate, liver enzymes, and cerebrospinal fluid (CSF) protein. Radiological work-up, including cerebral angiography, is often normal. Successful treatment includes administration of steroids and/or intravenous immunoglobulin (IVIg) or plasmapheresis. We describe a case of a 74-year-old male who presented for evaluation of abrupt onset confusion ultimately determined to be a consequence of autoimmune-mediated thyroiditis.

Copper Deficiency Myeloneuropathy in Autoimmune Disease.

Copper deficiency is a rare and potentially treatable cause of myeloneuropathy. The most common causes of acquired copper deficiency include malabsorption following gastric surgery and excessive zinc supplementation. Clinical manifestations can be localized to the dorsal spinal cord and present similarly to those that characterize classic vitamin B12 deficiency. In this report, we present the case of a 76-year-old female with copper deficiency myeloneuropathy as a presumed consequence of advanced systemic sclerosis (SSc).

Parkinson's Disease: Unanticipated Sequela of an Attempted Suicide.

Studies exploring the association between pesticide exposure and Parkinson's disease (PD) are largely limited to rural populations with occupational exposure. We could find no literature regarding PD occurring after ingestion of a pesticide. We present a case from our clinic of a man who developed PD following ingestion of a liquid pesticide during a suicide attempt. PD was diagnosed, and the patient's symptoms improved following initiation of carbidopa/levodopa. This case illustrates the potential role of ingested pesticide exposure in provoking and accelerating the manifestations of PD.