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Hashimoto’s encephalopathy is a steroid-responsive autoimmune disorder of chronic relapsing and remitting neuropsychological deficits associated with Hashimoto’s thyroiditis. A 61-year-old woman with a 15-year history of bipolar I disorder, who had been taking lithium and haloperidol, was admitted to the hospital because of altered mentality and muscular rigidity with a temperature of 39.5?C after intermittent cognitive impairment for 7 days. Laboratory studies revealed: increased muscle enzymes, high antithyroglobulin antibody and antimicrosome antibody, and high CSF protein levels without pleocytosis. Serum lithium level was elevated to 2.4 mmol/L. Based on a diagnosis of neuroleptic malignant syndrome (NMS) and lithium intoxication, hydration and hemodialysis to remove the causative drugs was started, which definitely improved her muscular rigidity and decreased serum CK levels, but she remained in comatose mentality and tetraplegia The EEG was abnormal with generalized delta activity and triphasic waves. Brain MRI revealed the lesion in both cerebral hemispheres and the corpus callosum. This is a rare case that Hashimoto’s encephalopathy resulted in the alteration of mental status, and then overdose of antipsychotic medications aggravated it by concurrence of NMS and lithium intoxication.
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