A case of hashimoto’s encephalopathy in a patient with lithium toxicity

Hashimoto’s encephalopathy is a rare neurological disorder of unknown etiology. We presented, a case of middle aged male with bipolar disorder on Lithium carbonate for 30 years, admitted with altered behavior for 2 weeks and high Lithium levels. He was admitted with the suspicion of Lithium toxicity. EEG showed generalized epileptiform discharges. MRI brain revealed frontal cortical atrophy. CSF detailed report was normal. Further workup showed a high TSH level and positive anti-TPO (anti thyroid peroxidase) antibodies. Based on clinical picture, raised antibodies and no discernible cause, diagnosis of probable Hashimoto’s encephalopathy was made. He received pulse of methylprednisolone for five days and his symptoms improved dramatically. Our case report highlights the importance of diagnosing a rare neurological syndrome in a complex clinical scenario