Steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) with stroke like symptoms. A case report. (P5.104)

Objective: To report an unusual case of Steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) with stroke like symptoms. Background: SREAT is a rare disorder commonly seen in females. Two clinic subtypes have been described, encephalopathic and vasculitic types. The hallmark-presenting feature is a nonspecific encephalopathy. Additional manifestations include, seizures, aphasia, extrapyramidal signs, myoclonus, gait disorder, neuropsychiatric symptoms and stroke-like episodes. Corticosteroids are the main stay of therapy. Design and methods: Case report and pertinent literature review. Results: 32 year old female without any significant past medical history presented with numbness of right face, right upper extremity along with right hand grip weakness. Neurological examination only revealed right pronator drift and right upper extremity sensory hypoesthesia to light touch and pin prick. MRI showed white mater hyper-intensities in the cortical and sub cortical region with minimal enhancement. CSF glucose, protein, cell count within normal range. CSF oligiclonal bands, IgG index and meningoencephalitis panel was negative. Autoimmune work including NMDAR, VGKC and paraneoplastic panel was negative. CT angiogram of the head and neck was not suggestive of vasculitis. Work up revealed significantly elevated thyroid peroxidase antibodies (602 IU/ml, normal <9). Following corticosteroids there was clinical as well as radiological improvement. SREAT is a rare disorder and stroke like presentation is uncommon and reported only in 27[percnt] of cases. In addition to elevated anti TPO antibodies high prevalence of anti alpha-enolase auto antibodies (anti-NAE) are reported in patients with SREAT. Vasculitic process is proposed because alpha-enolase is expressed on endothelial cells, which could lead to the disruption of the cerebral microvasculature. Conclusion: Clinicians should consider SREAT in the differential diagnosis of patients presenting with stroke like symptoms/vasculitis especially if investigations fail to establish a diagnosis. Disclosure: Dr. Javalkar has nothing to disclose. Dr. Abbas has nothing to disclose. Dr. Harris has nothing to disclose.