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Selim and Drachman described six patients with a progressive sporadic adult onset cerebellar degeneration.1 Raised concentrations of antithyroid antibodies were found. Modest increases in antithyroid antibodies were considered to be the result of longstanding autoimmune thyroid disease. Analysis of CSF showed increased protein concentrations in one patient. Brain MRI disclosed atrophy of the vermis in four patients and showed a concomitant atrophy of the brain stem in two patients. Treatment with L-thyroxine did not improve cerebellar signs. The authors suggested that ataxia associated with Hashimoto's disease could be due to an autoimmune cerebellar degeneration.
This is a very interesting finding, which raises several issues for the diagnosis and management of sporadic adult onset cerebellar degeneration. I make three comments. Firstly, …