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Hashimoto encephalopathy — SCE Neurology MCQ

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HardNeurogenetics and NeuroimmunologyHashimoto encephalopathySCE Neurology

A young adult develops subacute memory loss, psychiatric change, focal seizures and faciobrachial dystonic episodes with hyponatraemia. MRI is initially normal. Which investigation and treatment strategy is most appropriate?

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Correct answer: E — Send paired serum and CSF neuronal-antibody studies

The best answer is “Send paired serum and CSF neuronal-antibody studies”. The phenotype strongly suggests LGI1 autoimmune encephalitis; normal MRI or CSF does not exclude it, and early immunotherapy improves outcomes. “Diagnose Hashimoto encephalopathy from thyroid-peroxidase antibodies alone” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Wait for MRI abnormalities before investigating autoimmune encephalitis” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Treat only with antiseizure medication because cognition will recover” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Exclude autoimmune disease because CSF cell count is normal” is a credible alternative elsewhere, but it fails the decisive discriminator in this case.

Reference: Association of British Neurologists autoimmune encephalitis guideline: https://pn.bmj.com/content/21/5/412