Steroid-responsive encephalopathy in Hashimoto's thyroiditis caused by cerebral vasculitis?

Hashimoto encephalopathy is a syndrome of encephalopathy and high serum antithyroid antibodies of still unclear pathogenesis. It may be caused by immunologically mediated cerebral vasculitis or unidentified anti-neuronal autoantibodies. We report a 24 year old patient with diabetes mellitus type I complaining about abdominal pain and vomiting and presenting with ketoacidosis, elevated CRP and thrombopenia. 14 days ago thyreostatic therapy was initiated due to hyperthyroidism. On examination she was subfebrile, somnolent and confused. Brain CT, CSF and repeated TEE were normal. Thoracal and abdominal CT showed pl…