TPO and Mental deterioration: HE was clinically specified according to the following commonly used criteria: (i) encephalopathy signs (cognitive decline and further NPS), (ii) presence of serum TPO-Abs (>200 U/mL), (iii) exclusion of infectious, metabolic, paraneoplastic, or toxic etiologies (by serum, CSF, and brain imaging), and (iv) marked improvement of symptoms after administration of steroids or immunosuppression [1, 2].