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Kiliç AK, Kaymakamzade B, Saka E, Tan E. The Sole Initial Imaging Finding in Creutzfeldt-Jacob Disease: Focal FDG-PET Hypometabolism. Noro Psikiyatr Ars 2018; 56:226-228. [PMID: 31523152 DOI: 10.5152/npa.2017.19471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/16/2017] [Indexed: 11/22/2022] Open
Abstract
Laboratory studies such as electroencephalography, cerebrospinal fluid examination and diffusion-weighted magnetic resonance imaging (DWI-MRI) are valuable in the diagnosis of Creutzfeldt-Jacob disease (CJD),. However, these laboratory studies may not show the characteristic findings in the very early stage of the disease. Here, we present a case of CJD who had atypical neurologic presentation initially and had only a focal parietal 2-(18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) hypometabolism as the sole imaging abnormality at the beginning. The patient progressed rapidly, and showed typical neurological findings for CJD. The brain MRI was performed two weeks after the FDG-PET study, finally demonstrated increased signal intensity in DWI in caudat nucleus, putamen, and cerebral cortex, especially on left parietal region. Imaging methods demonstrating functional alterations in the brain should be obtained in the early period in patients with normal MRI suspected having CJD. Repeating DWI could also be an effective diagnostic approach.
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Affiliation(s)
- Ahmet Kasım Kiliç
- Neurology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bahar Kaymakamzade
- Neurology Department, Near East University Faculty of Medicine, Lefkoşa, Cyprus
| | - Esen Saka
- Neurology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ersin Tan
- Neurology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
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TAŞKAPILIOĞLU Ö, SEFEROĞLU M, YURTOĞULLARI Ş, HAKYEMEZ B, ERER S, KARLI N, BAKAR M, TURAN ÖF, ZARİFOĞLU M, TOLUNAY Ş, BORA İ. Sporadic Creutzfeldt-Jacob Disease: An 8-Year Experience from a Single Center in Turkey. Noro Psikiyatr Ars 2013; 50:306-311. [PMID: 28360562 PMCID: PMC5363421 DOI: 10.4274/npa.y5903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 07/03/2012] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Our aim was to conduct a retrospective review to demonstrate the clinical, radiological, and electrophysiological features of patients with sporadic Creutzfeldt-Jacob disease (sCJD). METHOD A total of 10 patients (5 female and 5 male, with a mean age of 45 years from a range of 40 to 67 years) out of 8.259 adult patients hospitalized from January 2000 to December 2008 were diagnosed with sCJD. RESULTS Eight of the patients were diagnosed on the basis of clinical, radiological, electroencephalography (EEG), and cerebrospinal fluid (CSF) findings. Two other patients also had a pathological diagnosis. The most common signs and symptoms were behavioral disturbances, movement disorders, cognitive decline, myoclonus, psychosis, focal neurological deficit, and aphasia. Nine of the patients had periodic sharp wave discharges on EEG. Seven patients were positive for the 14.3.3 protein in the CSF. Five patients had pulvinar signs-a bilateral increased signal in the pulvinar thalami-on cranial magnetic resonance imaging. Eight patients were diagnosed with probable sCJD; two were diagnosed with definite sCJD. All of the patients died as a result of the disease within 24 months after the onset of symptoms. DISCUSSION sCJD should be considered in the diagnosis of patients who present with rapidly progressive dementia. Clinical and radiological data appear to be sufficient for the diagnosis. However, detailed molecular examinations of the subtypes of the disease may be required for early diagnosis of cases given the wide spectra of CJD.
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Affiliation(s)
- Özlem TAŞKAPILIOĞLU
- Uludağ University Faculty of Medicine, Department of Neurology, Bursa, Turkey
| | - Meral SEFEROĞLU
- Uludağ University Faculty of Medicine, Department of Neurology, Bursa, Turkey
| | - Şükran YURTOĞULLARI
- Uludağ University Faculty of Medicine, Department of Neurology, Bursa, Turkey
| | - Bahattin HAKYEMEZ
- Uludağ University Faculty of Medicine, Department of Pathology, Bursa, Turkey
| | - Sevda ERER
- Uludağ University Faculty of Medicine, Department of Neurology, Bursa, Turkey
| | - Necdet KARLI
- Uludağ University Faculty of Medicine, Department of Pathology, Bursa, Turkey
| | - Mustafa BAKAR
- Uludağ University Faculty of Medicine, Department of Neurology, Bursa, Turkey
| | - Ö. Faruk TURAN
- Uludağ University Faculty of Medicine, Department of Neurology, Bursa, Turkey
| | - Mehmet ZARİFOĞLU
- Uludağ University Faculty of Medicine, Department of Neurology, Bursa, Turkey
| | - Şahsine TOLUNAY
- Uludağ University Faculty of Medicine, Department of Pathology, Bursa, Turkey
| | - İbrahim BORA
- Uludağ University Faculty of Medicine, Department of Neurology, Bursa, Turkey
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Valverde AH, Costa S, Timoteo A, Ginestal R, Pimentel J. Rapidly progressive corticobasal degeneration syndrome. Case Rep Neurol 2011; 3:185-90. [PMID: 21941496 PMCID: PMC3177789 DOI: 10.1159/000329820] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Corticobasal syndrome (CBS) has a heterogeneous clinical presentation with no specific pathologic substratum. Its accurate diagnosis is a challenge for neurologists; in order to establish CBS definitively, postmortem confirmation is required. Some clinical and radiological features can help to distinguish it from other neurodegenerative conditions, such as Creutzfeldt-Jakob disease (CJD). Clinical Case A 74-year-old woman presented with language impairment, difficulty in walking and poor attentiveness that had begun 10 days before. Other symptoms, such as asymmetrical extra-pyramidal dysfunction, limb dystonia and ‘alien limb’ phenomena, were established over the next 2 months, with rapid progression. Death occurred 3 months after symptom onset. Laboratory results were normal. Initially, imaging only showed restricted diffusion with bilateral parieto-occipital gyri involvement on DWI-MRI, with unspecific EEG changes. An autopsy was performed. Brain neuropathology confirmed sporadic CJD (sCJD). Conclusions CBS is a heterogeneous clinical syndrome whose differential diagnosis is extensive. CJD can occasionally present with clinical characteristics resembling CBS. MRI detection of abnormalities in some sequences (FLAIR, DWI), as previously reported, has high diagnostic utility for sCJD diagnosis – especially in early stages – when other tests can still appear normal. Abnormalities on DWI sequencing may not correlate with neuropathological findings, suggesting a functional basis to explain the changes found.
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Affiliation(s)
- Ana Herrero Valverde
- Department of Neurology, Hospital Prof. Dr. Fernando Fonseca, EPE, Amadora, EPE/Hospital de Santa Maria, Lisbon, Portugal
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Fulbright RK, Hoffmann C, Lee H, Pozamantir A, Chapman J, Prohovnik I. MR imaging of familial Creutzfeldt-Jakob disease: a blinded and controlled study. AJNR Am J Neuroradiol 2008; 29:1638-43. [PMID: 18635614 DOI: 10.3174/ajnr.a1217] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The E200K mutation of the PRNP (prion protein) gene is the most common cause of familial Creutzfeldt-Jakob disease (fCJD), which has imaging and clinical features that are similar to the sporadic form. The purpose of this study was to conduct a controlled and blinded evaluation of the sensitivity and specificity of MR imaging in this unique population. MATERIALS AND METHODS We compared the MR imaging characteristics of 15 early stage familial CJD patients (age, 60 +/- 7 years) with a group of 22 healthy subjects from the same families (age, 61 +/- 8 years). MR imaging included diffusion-weighted imaging (DWI), T2-weighted fast spin-echo imaging, and a fluid-attenuated inversion recovery (FLAIR) sequence. The scans were rated for abnormalities by an experienced neuroradiologist blind to diagnosis, group assignment, age, and sex. RESULTS Thirteen of 15 fCJD subjects had abnormal MR imaging. FLAIR signal intensity abnormality in the caudate or putamen nuclei demonstrated a sensitivity of 87% and specificity of 91%. DWI abnormality in the caudate nucleus showed a sensitivity of 73% and a specificity of 100%. Abnormalities in the thalamus (6 patients), cingulate gyrus (6 patients), frontal lobes (4 patients), and occipital lobes (3 patients) were best detected with DWI. No signal intensity abnormalities were demonstrated in the cerebellum. T2-weighted and T1-weighted sequences were uninformative. CONCLUSIONS FLAIR and DWI abnormalities in the caudate nucleus and putamen offer the best sensitivity and specificity for diagnosing fCJD. Our findings support recent recommendations that MR imaging should be added to the diagnostic evaluation of CJD.
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Affiliation(s)
- R K Fulbright
- Department of Radiology, Yale University School of Medicine, New Haven, CT 06520- 8043, USA.
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Romano A, Bozzao A, Tisei P, Fantozzi L. Emerging Patterns of Diffusion, Perfusion-Weighted MRI and Spectroscopy in Creutzfeldt-Jacob Disease. Neuroradiol J 2007; 20:56-60. [DOI: 10.1177/197140090702000109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 01/14/2007] [Indexed: 11/17/2022] Open
Abstract
Sporadic Creutzfeldt-Jacob disease (CJD) is a transmissible, progressive, fatal spongiform encephalopathy. Routine MR imaging sequences may show abnormalities in the basal ganglia and cerebral cortex. Recently, several reports claimed that diffusion weighted MRI (DWI) could demonstrate early brain lesions in CJD patients when conventional MR images are normal on T2-weighted sequences. We evaluated the usefulness of DWI, perfusion-weighted MRI (PWI) and spectroscopy to confirm the clinical diagnosis and assess lesion progression in two patients with suspected CJD. We noted a diffuse hypoperfusion in the basal ganglia where ADC values were reduced but spectroscopy values were normal. A strong hypoperfusion was observed in the right head of the caudate nucleus in patient n° 2 where spectroscopy values were abnormal. A typical distribution of hypoperfusion followed the posterior progression of disease. We suggest the hypoperfusion in the areas presenting restricted diffusion probably reflects spongiform degeneration and moderate mass effects from cytotoxic edema.
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Affiliation(s)
- A. Romano
- S. Andrea Hospital, La Sapienza University; Rome, Italy
| | - A. Bozzao
- S. Andrea Hospital, La Sapienza University; Rome, Italy
| | - P. Tisei
- S. Andrea Hospital, La Sapienza University; Rome, Italy
| | - L.M. Fantozzi
- S. Andrea Hospital, La Sapienza University; Rome, Italy
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Fulbright RK, Kingsley PB, Guo X, Hoffmann C, Kahana E, Chapman JC, Prohovnik I. The imaging appearance of Creutzfeldt-Jakob disease caused by the E200K mutation. Magn Reson Imaging 2006; 24:1121-9. [PMID: 17071334 DOI: 10.1016/j.mri.2006.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2005] [Revised: 07/05/2006] [Accepted: 07/05/2006] [Indexed: 11/26/2022]
Abstract
The E200K mutation on chromosome 20 can cause familial Creutzfeldt-Jakob disease (CJD). Patients with this mutation are clinically similar to those with sporadic CJD, but their imaging features are not well documented. We report here the quantitative and qualitative evaluation of the magnetic resonance (MR) imaging characteristics of this unique group of patients using three-dimensional spoiled gradient recalled (SPGR) echo images, diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) measurements, MR spectroscopy and a fluid-attenuated inversion recovery (FLAIR) sequence. The SPGR and ADC data were analyzed with SPM99. ANCOVA and regression models were used for a region-of-interest (ROI) analysis of ADC and metabolic ratios. CJD patients had a decreased fraction of gray matter and an increased fraction of cerebrospinal fluid (P=.001) in the cortex and cerebellum and increased ADC values in the cortex (P<.001). Focal decreases of ADC were found in the putamen via ROI analysis (548+/-83 vs. 709+/-9 microm(2)/s, P=.02). N-acetyl aspartate (NAA) was generally reduced, with the NAA/Cho ratio lowest in the cingulate gyrus. Qualitative assessment revealed hyperintensities on FLAIR, DWI or both in the putamen (three out of four patients), caudate (three out of four patients) and thalamus. These results provide a framework for future study of patients with genetically defined familial CJD.
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Affiliation(s)
- Robert K Fulbright
- Department of Radiology, Yale University School of Medicine, MRRC, The Anlyan Center N137, P.O. Box 208043, New Haven, CT 06520-8043, USA.
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Tsuboi Y, Baba Y, Doh-ura K, Imamura A, Fujioka S, Yamada T. Diffusion-weighted MRI in familial Creutzfeldt–Jakob disease with the codon 200 mutation in the prion protein gene. J Neurol Sci 2005; 232:45-9. [PMID: 15850581 DOI: 10.1016/j.jns.2005.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Revised: 01/11/2005] [Accepted: 01/12/2005] [Indexed: 10/25/2022]
Abstract
Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) has been reported to be a useful tool for early diagnosis of sporadic Creutzfeldt-Jakob disease (CJD). We report MRI findings with DWI, as well as with fluid-attenuated inversion recovery (FLAIR) and T1-weighted imaging (T1WI), in a case of familial CJD with a mutation at codon 200 of the prion protein gene. DWI in this patient showed high signal intensity in the basal ganglia and the cerebral cortex, similar to findings in sporadic CJD. In addition, T1WI showed areas of high signal intensity bilaterally in the globus pallidus. Despite the clinical diversity and atypical laboratory findings seen in familial CJD with the codon 200 mutation, these neuroimaging studies suggest that common regional distributions and a common pathogenesis might underlie the clinical progression both in sporadic CJD and in familial CJD with the codon 200 mutation in the prion protein gene. DWI abnormalities may be characteristic features that should be considered in the diagnosis of familial as well as of sporadic CJD.
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Affiliation(s)
- Yoshio Tsuboi
- Fifth Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Fukuoka 814-0180, Japan.
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Moreaud O, Monavon A, Brutti-Mairesse MP, Grand S, Lebas JF. Creutzfeldt-Jakob disease mimicking corticobasal degeneration. J Neurol 2005; 252:1283-4. [PMID: 15795791 DOI: 10.1007/s00415-005-0828-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2004] [Revised: 01/13/2005] [Accepted: 01/28/2005] [Indexed: 10/25/2022]
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