Hashimoto's Encephalopathy Presenting With Altered Mental Status and Myoclonus and Co-Occurring With Psoriasis
Bibliographic record
Abstract
We report the case of Hashimoto’s encephalopathy (HE) in a 48-year-old male who presented with sudden onset of unresponsiveness with reported confusion and behavioral changes 3 days prior. Metabolic derangement, infectious and toxic factors were ruled out through laboratory testing. Stroke was excluded through brain CT and MRI. Vasculitis panel was unremarkable. Extensive CSF study was unremarkable except for high protein consistent with similar finding in other reported cases of HE. His TSH was normal but his anti-thyroid peroxidase antibody was highly elevated indicative of HE. EEG showed diffuse slow wave pattern. 14-3-3 protein, which is a non-specific marker for Creutzfeldt-Jakob disease, was not detected. The patient showed marked improvement with corticosteroid treatment and his mental status returned to baseline. Our patient also has a history of psoriasis. While HE is reported to be associated with many autoimmune disorders, the currently reported co-occurrence with psoriasis is rare and this report, to the best of our knowledge, is only the second such report. We emphasize that HE should be considered as a differential diagnosis in patients with altered mental status when metabolic, infectious and toxic factors have been ruled out, early onset dementias can be ruled out, and presence of other autoimmune disorders are noted. Anti-thyroid peroxidase (anti-TPO) antibody, although being a non-specific marker, should be checked in such cases. J Med Cases. 2013;4(5):300-303 doi: https://doi.org/10.4021/jmc1144w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".