Abstract
A 77-year-old woman developed chronic renal failure and became dialysis-dependent. Her uremic syndrome was in remission after dialysis had started, but she became drowsy, accompanied by delirium and dementia. Computed tomography and magnetic resonance imaging of the brain showed diffuse brain atrophy and chronic ischemia, which seemed to involve age-related changes in the brain. However, her patterns of electroencephalographic activity showed slow-waves, which was suggestive of metabolic brain disease or autoimmune brain diseases. Although she was in euthyroid state, antithyroglobulin test was highly positive. In addition, anti N-terminal enolase antibody specific for autoimmune Hashimoto's encephalopathy was positive. Based on these results, the diagnosis of Hashimoto's encephalopathy was obtained. Oral prednisolone 30 mg per day was prescribed and her neuropsychiatric symptoms were ameliorated. In conclusion, as a cause of consciousness disorder and dementia with psychotic manifestations in dialysis-dependent patients, autoimmune Hashimoto's encephalopathy should be considered.
