Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 45 9 2016 10 10 1220 1223 Masoume NAZERI Clinical Neurology Research Center, Dept. of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran Amin ABOLHASANI FOROUGHI Medical Imaging Research Center, Dept. of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran Hora HEIDARI Clinical Neurology Research Center, Dept. of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran Sarvin SAJADIANFARD Clinical Neurology Research Center, Dept. of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran Tannaz EGHBALI Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Peyman ARASTEH Non Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran AND Dept. of Master of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran 2016 09 27 2016 09 27 A 33 yr old man, previously diagnosed with hypothyroidism, presented with decreased level of consciousness and generalized tonic-clonic (GTC) seizure to Namazi hospital, Shiraz, Iran, during April 2015. The patient later referred with another episode of seizure like attack for which he received phenytoin, carbamazepine and levothyroxine and was discharged. During his last admission, the patient was admitted with chief complaints of decreased consciousness and four GTC attacks. On admission, the patients had aphasia, ataxia, loss of verbal communication, eye contact and complete loss of obedience. Thyroid function tests showed low levels of T3 and T4 with high levels of thyroid stimulating hormone. Other blood tests were all either normal or slightly abnormal. Lumbar puncture and CSF analysis had a high titer of Anti-TPO antibodies. With high suspicion of Hashimoto encephalopathy, pulsed methyl prednisolone (10 mg) was administered, however the patient showed little improvement. Therefore, plasmaphresis was started, to which the patient showed dramatic response.   https://ijph.tums.ac.ir/index.php/ijph/article/view/7858 https://ijph.tums.ac.ir/index.php/ijph/article/download/7858/5559