Metabolic Encephalopathy in Elderly with a Special Focus on Thyroid Function and Hashimotos Encephalopathy
Journal Title: Journal of Medical Science And clinical Research - Year 2017, Vol 5, Issue 10
Abstract
Objective: Metabolic encephalopathy is a common cause for morbidity and mortality in elderly. Metabolic disturbances are frequent causes of impaired consciousness and their presence must always be considered when there are no focal signs of cerebral disease. An underdiagnosed but potentially treatable cause of metabolic encephalopathy in elderly is Hashimoto’s encephalopathy (HE). It has huge clinical relevance since it is not uncommon and shows very good response to immunosuppressive treatment. The aim of the study was to analyse the various causes of metabolic encephalopathy in elderly patients. Various presenting features of encephalopathy particularly involuntary movements have also been studied. Cases of Hashimoto’s encephalopathy have been specifically sought for and looked into to characterise the specific clinical manifestations that can point towards its diagnosis. Materials and Methods: Our study was a hospital based descriptive study conducted in elderly patients above the age of 60 years admitted with altered sensorium. Patients with documented sepsis, hepatic failure ,renal failure, cerebrovascular accident, CNS infection and head injury were excluded from the study. A thorough clinical examination including detailed neurological examination was done. Blood was sent for investigations including serum electrolytes, hepatic, renal and throid function tests. Those patients who did not had any obvious cause for encephalopathy and not responding to treatment were further evaluated with anti TPO antibodies in CSF. Results: Of the 132 patients enrolled in the study there were 55males (41.7%) and 77 females (58.3%). Seizures was seen in 15.9% and myoclonus in 3.8% patients. Study showed that 92.4% of patients had hyponatremia and 7.6% had normonatremia. The patients having blood glucose values above 500 mg% and below 50 mg% were 4.5%, and 7.6%. Thus our study showed 7.6% of patients had hypoglycaemic encephalopathy Thyroid status of the patients showed that clinical hypothyroidism was seen in 3.8% and subclinical hypothyroidism in 15.4%. Majority of the patients were euthyroid(80.8%).The CSF examination showed 14 patients (10.6%) positive for anti TPO antibodies and were diagnosed to have hashimotos encephalopathy.Among the patients with hashimotos encephalopathy 71.4% were females , 57.2 % patients had abnormal movements at presentation , 64.3 % patients had hyponatremia and 78.5 % had a euthyroid status. Conclusion: Hyponatremia and altered blood glucose levels were the major causes leading to metabolic encephalopathy in elderly patients. About 10.6% of the elderly patients presented with hashimotos encephalopathy. Abnormal movements were an important presenting feature of hashimotos encephalopathy. A Significant proportion of patients with hashimotos encephalopathy had euthroid status. A high level of clinical suspicion is needed for the diagnosis, as it is a treatable condition
Authors and Affiliations
Dr Praveen. P
Keywords
Related Articles
- EP ID EP528516
- DOI -
- Views 68
- Downloads 0
Oxidant and Antioxidant Activity Alteration in Anaplastic Astrocytomas Patients Following Radiation Therapy
Radiation therapy has been used in cancer treatment for many decades, although effective in killing tumor cells, ROS produced in radiotherapy threaten the integrity and survival of surrounding normal cells. Radiation dam...
Histogenesis of Human Fetal Thymus in 1st and 2nd Trimester
The thymus is the lymphoid organ that consists of lymphoid and epithelial cells The thymus is composed of two identical lobes and is located anatomically in the anterior superior mediastinum. In spite of remarkable progr...
Needs to Define Physical Fitness Centres in India - An Analytical Study
Introduction: An increased awareness to promote physical fitness, especially gym goers was recorded globally. However due regulation and the needs of fitness industry including qualified trainers, due monitoring are logg...
Tension Pneumoperitoneum and Abdominal Compartment Syndrome Rare Complication of Percutaneous Radiological Gastrostomy, Case Report and Literature Review
Tension pneumoperitoneum (TP) is defined as the massive accumulation of air in the peritoneal cavity, which results in a sudden increase in intraabdominal pressure. Various iatrogenic procedures are responsible for this...
Hair Dye Poisoning with Refractory Arrthymia & Interstitial Nephritis Rare Presentation
A 45year old female with no comorbid illness brought to emergency room with alleged history of consumption of 100ml of hair dye at 10am at her residence. She was initially treated at government hospital and brought to ou...