Hashimoto´S Encephalopathy: Diagnosis by Exclusion in an Atypical Case

Hashimoto's encephalopathy is a rare disease with an estimated prevalence of 2.1 cases per 100,000 people, due to its nonspecific clinical presentation, a predilection for the female sex, and an age group between the fourth and fifth decades of life. This pathology describes a variety of brain disorders that result in altered brain function, manifesting as cognitive impairment, behavioral changes, memory problems, and even neurological symptoms. For a correct diagnosis, we must have a clinical suspicion based on sex, age group, clinical presentation with neurological alterations without etiology that meet the six criteria, include laboratory and imaging studies to rule out infectious causes, anatomical, functional, and hormonal alterations, with the search for specific antibodies (anti-Tg and anti-TPO) against this autoimmune thyroid disease, making use of special imaging studies such as plain and contrast cranial MRI. The mainstay of treatment for this condition is steroids, which have a good response; however, it presents a diagnostic and therapeutic challenge in our setting due to its low prevalence and underdiagnosed cases, with a very low number of reported cases.