MRI and steroid-responsive encephalopathy associated with autoimmune thyroiditis: first report of conus medullaris involvement and literature review of the known neuroimaging profiles

BackgroundSteroid-responsiveencephalopathy associated with autoimmune thyroiditis (SREAT) is a rare butpotentially reversible autoimmune encephalopathy. The most frequentneuroimaging correlates are normal brain MRI or non-specific white matterhyperintensities.MethodsWe present the first description of conus medullaris involvement, also providing an extensive review of MRI patterns described so far.ResultsOur results show that in less than 30% of cases, it is possible to find focal SREAT neuroanatomical correlates. Among these, T2w/FLAIR temporal hyperintensities are the most frequent, followed by basal ganglia/thalamic and brainstem involvement, respectively.ConclusionsUnfortunately, spinal cord investigation is an uncommon practice in the diagnostic approach of encephalopathies, thus neglecting potential pathological lesions of the medulla spinalis. In our opinion, the extension of the MRI study to the cervical, thoracic, and lumbosacral regions may allow finding new, and hopefully specific, anatomical correlates.