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Creutzfeldt-Jakob Disease Presenting as Expressive Aphasia and Nonconvulsive Status Epilepticus. Case Rep Crit Care 2018; 2018:5053175. [PMID: 29666711 PMCID: PMC5832162 DOI: 10.1155/2018/5053175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/18/2017] [Accepted: 01/15/2018] [Indexed: 12/27/2022] Open
Abstract
Creutzfeldt-Jakob disease (CJD), the most common form of human prion diseases, is a fatal condition with a mortality rate reaching 85% within one year of clinical presentation. CJD is characterized by rapidly progressive neurological deterioration in combination with typical electroencephalography (EEG) and magnetic resonance imaging (MRI) findings and positive cerebrospinal spinal fluid (CSF) analysis for 14-3-3 proteins. Unfortunately, CJD can have atypical clinical and radiological presentation in approximately 10% of cases, thus making the diagnosis often challenging. We report a rare clinical presentation of sporadic CJD (sCJD) with combination of both expressive aphasia and nonconvulsive status epilepticus. This patient presented with slurred speech, confusion, myoclonus, headaches, and vertigo and succumbed to his disease within ten weeks of initial onset of his symptoms. He had a normal initial diagnostic workup, but subsequent workup initiated due to persistent clinical deterioration revealed CJD with typical MRI, EEG, and CSF findings. Other causes of rapidly progressive dementia and encephalopathy were ruled out. Though a rare condition, we recommend consideration of CJD on patients with expressive aphasia, progressive unexplained neurocognitive decline, and refractory epileptiform activity seen on EEG. Frequent reimaging (MRI, video EEGs) and CSF examination might help diagnose this fatal condition earlier.
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Caine D, Tinelli RJ, Hyare H, De Vita E, Lowe J, Lukic A, Thompson A, Porter MC, Cipolotti L, Rudge P, Collinge J, Mead S. The cognitive profile of prion disease: a prospective clinical and imaging study. Ann Clin Transl Neurol 2015; 2:548-58. [PMID: 26000326 PMCID: PMC4435708 DOI: 10.1002/acn3.195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives Prion diseases are dementing illnesses with poorly defined neuropsychological features. This is probably because the most common form, sporadic Creutzfeldt-Jakob disease, is often rapidly progressive with pervasive cognitive decline making detailed neuropsychological investigation difficult. This study, which includes patients with inherited, acquired (iatrogenic and variant) and sporadic forms of the disease, is the only large-scale neuropsychological investigation of this patient group ever undertaken and aimed to define a neuropsychological profile of human prion diseases. Methods A tailored short cognitive examination of all of the patients (n = 81), with detailed neuropsychological testing in a subset with mild disease (n = 30) and correlation with demographic, clinical, genetic (PRNP mutation and polymorphic codon 129 genotype), and other variables (MRI brain signal change in cortex, basal ganglia or thalamus; quantitative research imaging, cerebrospinal fluid 14-3-3 protein). Results Comparison with healthy controls showed patients to be impaired on all tasks. Principal components analysis showed a major axis of fronto-parietal dysfunction that accounted for approximately half of the variance observed. This correlated strongly with volume reduction in frontal and parietal gray matter on MRI. Examination of individual patients' performances confirmed early impairment on this axis, suggesting characteristic cognitive features in mild disease: prominent executive impairment, parietal dysfunction, a largely expressive dysphasia, with reduced motor speed. Interpretation Taken together with typical neurological features, these results complete a profile that should improve differential diagnosis in a clinical setting. We propose a tailored neuropsychological battery for early recognition of clinical onset of symptoms with potential for use in clinical trials involving at-risk individuals.
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Affiliation(s)
- Diana Caine
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust London, United Kingdom ; Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Renata J Tinelli
- Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust London, United Kingdom
| | - Harpreet Hyare
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Enrico De Vita
- Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology London, United Kingdom ; Lysholm Department of Neuroradiology, NHNN, University College London Hospitals NHS Foundation Trust London, United Kingdom
| | - Jessica Lowe
- Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Ana Lukic
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Andrew Thompson
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Marie-Claire Porter
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Lisa Cipolotti
- Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust London, United Kingdom
| | - Peter Rudge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - John Collinge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Simon Mead
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
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