Hashimoto's Encephalopathy / SREAT Alliance
Our mission is to support patients and caregivers, raise awareness, and advocate for vital research for Hashimoto's Encephalopathy and Seronegative Autoimmune Encephalitis.
DIAGNOSIS and TREATMENTS
HASHIMOTO'S ENCEPHOLAPATHY
For a diagnosis of Hashimoto's Encephalopathy all 6 of the following criteria must be met:
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Encephalopathy with seizures, myoclonus, hallucinations, or stroke-like episodes
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Subclinical or mild overt thyroid disease (usually hypothyroidism)
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Brain MRI normal or with non-specific abnormalities
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Presence of serum thyroid (thyroid peroxidase, thyroglobulin) antibodies*
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Absence of well characterised neuronal antibodies in serum and CSF
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Reasonable exclusion of alternative causes
For a diagnosis of autoantibody (sero)- negative (probable autoimmune encephalitis), the following four criteria must be met:
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​Rapid progression
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Working memory deficits
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Short-term memory loss,
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Altered mental status or psychiatric symptoms
Criteria for autoantibody-negative but probable autoimmune encephalitis
Clinical Approach
HASHIMOTO'S ENCEPHOLAPATHY
A detailed clinical history
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Complete general examination
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Complete neurological examination
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Routine blood plus
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Antithyroid autoantibodies including Thyroid Peroxidase Antibody (TPO) or Thyroglobulin Antibody (TgAb) Thyroid and Stimulating Hormone Receptor Antibody (TRAb)
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inflammation markers such as C-reactive protein or erythrocyte sedimentation rate (ESR)
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Vitamin deficiency
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Heavy metals
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Oligoclonal bands (tests can be from a lumbar puncture as well)
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CSF analysis
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Opening pressure in the CSF
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Viral and bacterial encephalitis
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Meningitis
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Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid (ENC2 Mayo Clinic)
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Protein
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Glucose
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Oligoclonal bands
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Lymphocytic pleocytosis
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FDG-PET or SPECT
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Brain MRI including diffusion sequences (may show normal or nonspecific brain MRI abnormalities)
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EEG: (may show seizure-activity or slight slowing)
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Neuropsychological testing
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1.A clinical approach to diagnosis of autoimmune encephalitis Graus, Francesc et al.The Lancet Neurology, Volume 15, Issue 4, 391 - 404
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​Tardieu M, Deiva K. Rare inflammatory diseases of the white matter and mimics of multiple sclerosis and related disorders. Neuropediatrics. 2013 Dec;44(6):302-8. doi: 10.1055/s-0033-1358599. Epub 2013 Oct 28. PMID: 24166147.
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SERONEGATIVE AUTOIMMUNE ENCEPHALITIS
A detailed clinical history
​
Complete general examination
​
Complete neurological examination
​
Routine blood plus​
-
Inflammation markers such as C-reactive protein or erythrocyte sedimentation rate (ESR)
-
Vitamin deficiency
-
Heavy metals
-
Oligoclonal bands (tests can be from a lumbar puncture as well)
-
autoantibodies in serum
​
CSF analysis
-
Opening pressure in the CSF
-
Viral and bacterial encephalitis
-
Meningitis
-
Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid (ENC2 Mayo Clinic)
-
Protein
-
Glucose
-
Oligoclonal bands
-
Lymphocytic pleocytosis
​
FDG-PET or SPECT
​
Brain MRI including diffusion sequences (may show abnormalities suggestive of autoimmune encephalitis)
​
EEG: (may show seizure-activity or slight slowing)
​
Neuropsychological testing
​​​​​
​
1.A clinical approach to diagnosis of autoimmune encephalitis Graus, Francesc et al.The Lancet Neurology, Volume 15, Issue 4, 391 - 404
​
​Tardieu M, Deiva K. Rare inflammatory diseases of the white matter and mimics of multiple sclerosis and related disorders. Neuropediatrics. 2013 Dec;44(6):302-8. doi: 10.1055/s-0033-1358599. Epub 2013 Oct 28. PMID: 24166147.
​
The following is a suggested clinical approach to diagnosis that is accessible to most physicians.The following content is for informational purposes only and should not be used to replace the advice of a qualified healthcare professional.
