Palatal tremor and myorhythmia in Hashimoto’s encephalopathy

Abstract

Hashimoto’s encephalopathy (HE) is an autoimmune cerebral vasculitis that affects a subset of patients with Hashimoto’s thyroiditis.1-4⇓⇓⇓ Clinical manifestations include cognitive impairment, stupor, seizures, involuntary movements, or stroke-like episodes.1-3⇓⇓ The onset of symptoms is usually acute or subacute, followed by a progressive or relapsing–remitting course.1-3⇓⇓ The detection of anti-thyroid antibodies in serum is critical for diagnosis.1-3⇓⇓ Myoclonus, either generalized or multifocal, and tremor, often of the bilateral upper extremities, are the most frequently observed involuntary movements in HE.1-3⇓⇓ Opsoclonus and generalized chorea also have been reported in isolated patients.1,3,5⇓⇓ We describe two patients with HE who manifested previously unreported, distinctive tremors that implicate dysfunction of the dentato-olivary pathway. A 34-year-old man was transferred to our institution 8 weeks after the acute onset of stupor, tremor of the face and arms, and occasional generalized convulsive seizures. He was afebrile. His sensorium fluctuated from deep stupor to severe agitation. Continuous, …