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Case Reports
. 2018 Feb;97(7):e9949.
doi: 10.1097/MD.0000000000009949.

A thyroid storm patient with protracted disturbance of consciousness and reversible lesion in the splenium of corpus callosum: A case report

Chihiro Namatame  1 , Tomohiro Sonoo, Kazutaka Fukushima, Hiromu Naraba, Hideki Hashimoto, Kensuke Nakamura
Affiliations
Case Reports

A thyroid storm patient with protracted disturbance of consciousness and reversible lesion in the splenium of corpus callosum: A case report

Chihiro Namatame et al. Medicine (Baltimore). 2018 Feb.

Abstract

Rationale: Various neurological manifestations are observed in thyroid storm patients but protracted disturbance of consciousness is rare.

Patient concerns: A 58-year-old male was admitted to our hospital after a traffic accident.

Diagnoses: Although awake on arrival, he fell into coma after admission. Based on the clinical symptoms and hyperthyroidism, the patient was diagnosed with thyroid storm (TS).

Interventions: Even after improvement of hyperthyroidism, disturbance of consciousness was protracted. Considering the possibility of immune-related etiology, methylprednisolone pulse was started.

Outcomes: His consciousness level improved over a 3-month period, and he became able to walk with some assistance after 6 months.

Lessons: His condition was atypical of TS-associated encephalopathy because of the long clinical course. Reversible splenial lesion was visible using brain imaging. In some cases of TS, disturbance of consciousness can be protracted for several months, but it is reversible. Therefore, it is necessary to judge the long-term neurological outcome carefully.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Brain MRI on the eighth hospital day. (A) T1 weighed image (T1WI); (B) fluid attenuated inversion recovery (FLAIR); (C) diffusion weighted image (DWI); (D) apparent diffusion coefficient (ADC) map) and 7 months after symptom onset; (E) T1WI; (F) FLAIR; (G) DWI; (H) ADC map. On acute phase, the splenium of the corpus callosum (SCC) lesion appeared DWI high intensity with low ADC (arrow). Lesions in bilateral thalami and cerebral white matter (arrowhead) showed high intensity in FLAIR and high intensity in DWI with low ADC. After 7 months, the SCC lesion disappeared but cerebral atrophy progressed. ADC = apparent diffusion coefficient, DWI = diffusion weighted image, FLAIR = fluid attenuated inversion recovery SCC = splenium of the corpus callosum, T1WI = T1 weighed image.
Figure 2
Figure 2
Treatment and clinical course of our case: hANP (human atrial natriuretic peptide); NAd, (noradrenalin); KI, (potassium iodine); and MMI, (thiamazole). human hANP = atrial natriuretic peptide, KI = potassium iodine, MMI = thiamazole, NAd = noradrenalin.
See this image and copyright information in PMC

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