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Ling K, Das S, Vydianath S. Referral of a Patient With Ocular Symptoms to the Stroke Clinic: Not Always the Usual Suspect! Cureus 2024; 16:e53912. [PMID: 38465143 PMCID: PMC10925027 DOI: 10.7759/cureus.53912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
A 77-year-old male attended the stroke clinic as a delayed presentation of a stroke and was initially managed as an occipital stroke. He presented with a gradual decline in visual acuity with an initial suspicion of field deficit over a period of three to four months. He underwent extensive tests including imaging for a confirmatory diagnosis. He had a rapid deterioration of his vision, function, and cognition over a few weeks resulting eventually in death. The case highlights a rare variant of sporadic Creutzfeld-Jakob disease (sCJD), the Heidenhain Variant (HV-CJD). CJD is the commonest of human prion diseases. In HV-CJD, pathologic prions display demyelinating neurotropism for the occipital lobes resulting in visual changes and hallucinations.
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Affiliation(s)
- Kayteck Ling
- Geriatric Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
| | - Saugata Das
- Stroke Medicine, The Royal Wolverhampton NHS Trust, Wolverhampton, GBR
| | - Sanjay Vydianath
- Radiology, The Royal Wolverhampton NHS Trust, Wolverhampton, GBR
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2
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Burke O, Jacobs JW, Tormey CA, Rinder HM, Figueroa Villalba CA, Lee ES, Silva Campos JJ, Abels E, Yurtsever N. Heidenhain variant of Creutzfeldt-Jakob disease masquerading as neuromyelitis optica spectrum disorder: recognizing when apheresis is not the answer. Lab Med 2023:lmad107. [PMID: 38142129 DOI: 10.1093/labmed/lmad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Abstract
The Heidenhain variant of Creutzfeld-Jakob disease (CJD) is a rare form that initially presents with visual disturbances. In early stages, the presentation can mimic neuromyelitis optica spectrum disorders (NMOSD) and lead to unnecessary treatment modalities. Herein, we describe a case of a 66-year-old man who presented with bilateral vision loss and retro-orbital discomfort. In addition to immunosuppressive therapy, he received 4 rounds of therapeutic plasma exchange after his preliminary diagnosis of NMOSD. We were surprised to note that his condition did not show improvement but deteriorated, with severe neurocognitive symptoms. Eventually, CJD was suspected, and real-time quaking-induced conversion (RT-QuIC) was performed. By the time the diagnosis of Heidenhain variant of CJD was confirmed, the patient was discharged to hospice care and died shortly after.
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Affiliation(s)
- Olivia Burke
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | | | - Henry M Rinder
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
- Internal Medicine (Hematology), Yale School of Medicine, New Haven, CT, US
| | | | - Edward S Lee
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Juan J Silva Campos
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Elizabeth Abels
- Department of Pathology, Baylor College of Medicine, Houston, TX, US
| | - Nalan Yurtsever
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
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3
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Fanella M, Valente G, Borrello L, Marinelli F, Bracaglia M, Di Marco O, Costanzo F, Apponi F, De Simone R. Non-convulsive status epilepticus versus periodic EEG pattern in sporadic Creutzfeldt-Jakob disease: two sides of the same coin? Int J Neurosci 2023:1-5. [PMID: 37855691 DOI: 10.1080/00207454.2023.2273775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/17/2023] [Indexed: 10/20/2023]
Abstract
Sporadic Creutzfeldt-Jakob disease is characterized by rapid cognitive and neuropsychiatric impairment. The Heidenhain variant of Creutzfeldt-Jakob disease is known for isolated visual disturbance that precedes other features. Periodic sharp wave complexes on EEG are typical of sporadic Creutzfeldt-Jakob disease, but at the onset, the electroclinical pattern may be unclear and suggest the hypothesis of a non-convulsive status epilepticus. Furthermore, non-convulsive status epilepticus and sporadic Creutzfeldt-Jakob disease could coexist simultaneously. We report the case of a patient admitted to our hospital for progressive psychiatric and cognitive disorders. In the initial phase, based on clinical, EEG, and neuroradiological features, a diagnosis of possible non-convulsive status epilepticus was made. Subsequently, the rapid neurological degeneration led to the diagnosis of Creutzfeldt-Jakob disease confirmed by cerebrospinal fluid real-time quaking-induced conversion. Non-convulsive status epilepticus could mimic Creutzfeldt-Jakob disease or be present in overlap. Antiseizure drugs may be started when the etiology is unclear, but overtreatment should be avoided when invasive treatment protocols fail, and the neurological progression suggests an encephalopathy.
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Affiliation(s)
| | - Giada Valente
- Radiology Unit, Hospital F. Spaziani, Frosinone, Italy
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4
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Kong Y, Chen Z, Zhang J, Wang X, Wu L. Clinical and Genetic Characteristics of the Heidenhain Variant of Creutzfeldt-Jakob Disease. Viruses 2023; 15:v15051092. [PMID: 37243178 DOI: 10.3390/v15051092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/22/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The Heidenhain variant of Creutzfeldt-Jakob disease (HvCJD), as a rare phenotype of CJD, has been under-recognized. We aim to elucidate the clinical and genetic features of HvCJD and investigate the differences of clinical features between genetic and sporadic HvCJD to improve our understanding of this rare subtype. METHOD HvCJD patients admitted to the Xuanwu Hospital from February 2012 to September 2022 were identified, and published reports on genetic HvCJD cases were also reviewed. The clinical and genetic features of HvCJD were summarized, and the clinical features between genetic and sporadic HvCJD were compared. RESULTS A total of 18 (7.9%) HvCJD patients were identified from 229 CJD cases. Blurred vision was the most common visual disturbance at the disease's onset, and the median duration of isolated visual symptoms was 30.0 (14.8-40.0) days. DWI hyperintensities could appear in the early stage, which might help with early diagnosis. Combined with previous studies, nine genetic HvCJD cases were identified. The most common mutation was V210I (4/9), and all patients (9/9) had methionine homozygosity (MM) at codon 129. Only 25% of cases had a family history of the disease. Compared to sporadic HvCJD, genetic HvCJD cases were more likely to present with non-blurred vision visual symptoms at onset and develop cortical blindness during the progression of the disease. CONCLUSIONS HvCJD not only could be sporadic, but also, it could be caused by different PRNP mutations. Sporadic HvCJD was more likely to present with blurred vision visual symptoms at onset, and genetic HvCJD was more likely to develop cortical blindness with the disease's progression.
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Affiliation(s)
- Yu Kong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhongyun Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jing Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xue Wang
- Department of Library, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Liyong Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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5
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Piñar-Morales R, Barrero-Hernández F, Aliaga-Martínez L. Human prion diseases: An overview. Med Clin (Barc) 2023:S0025-7753(23)00092-1. [PMID: 37088611 DOI: 10.1016/j.medcli.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 04/25/2023]
Abstract
Prion diseases are a group of neurodegenerative diseases. The disease-causing agent is a protein (PrP), that is normally produced in the nervous system, aggregated in an abnormal form. The abnormal protein, known as prion (PrPSc), is capable of self-propagation promoting the misfolding of the normal protein (PrP). These conditions can be acquired sporadically, genetically, or infectiously either by eating meat contaminated with prions or from iatrogenic exposure. The diagnosis of these diseases is often challenging. The use of highly sensitive and specific diagnostic tools, such as MRI and RT-QuIC, may aid in the diagnosis. Neuropathological examination of brain tissue ensures a definite diagnosis. At present, no treatment significantly improves the course of prion diseases; however, an early diagnosis is of paramount importance for patient care decision planning, infection control purposes, and genetic counseling.
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Affiliation(s)
- Raquel Piñar-Morales
- Departamento de Medicina, Facultad de Medicina, Universidad de Granada, Granada, España; Servicio de Neurología, Hospital Clínico San Cecilio, Granada, España
| | - Francisco Barrero-Hernández
- Departamento de Medicina, Facultad de Medicina, Universidad de Granada, Granada, España; Servicio de Neurología, Hospital Clínico San Cecilio, Granada, España
| | - Luis Aliaga-Martínez
- Departamento de Medicina, Facultad de Medicina, Universidad de Granada, Granada, España.
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6
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Best J, Chapleau M, Rabinovici GD. Posterior cortical atrophy: clinical, neuroimaging, and neuropathological features. Expert Rev Neurother 2023; 23:227-236. [PMID: 36920752 DOI: 10.1080/14737175.2023.2190885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Posterior Cortical Atrophy (PCA) is a neurodegenerative disorder characterized by impairment of higher-order visual processing in the setting of progressive atrophy of the parietal and occipital lobes. The underlying pathology is variable but most commonly Alzheimer's disease. The majority of individuals develop symptoms before 65 years of age; however, delayed diagnosis is common due to misattribution of symptoms to ocular rather than cortical pathology. AREAS COVERED The purpose of this review is to provide readers with an in-depth analysis of Posterior Cortical Atrophy syndrome, including clinical, imaging, pathological, and genetic features, management, and treatments. EXPERT OPINION Most patients present initially with a relatively pure visuoperceptual-visuospatial syndrome, though other cognitive domains become affected over time. Structural neuroimaging demonstrates parieto-occipital or temporo-occipital predominant atrophy. Cerebrospinal fluid Alzheimer's disease biomarkers, or amyloid/tau PET imaging can help evaluate for underlying Alzheimer's disease, which is the most common underlying neuropathology. The cornerstone of management is focused on nonpharmacologic measures. Early etiologic diagnosis is important with the arrival of disease-modifying therapies, especially for Alzheimer's disease.
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Affiliation(s)
- John Best
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Marianne Chapleau
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA.,Departments of Neurology, Radiology & Biomedical Imaging, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
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7
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Hisata Y, Yamashita S, Tago M, Yoshimura M, Nakashima T, Nishi TM, Oda Y, Honda H, Yamashita SI. Heidenhain Variant of Sporadic Creutzfeldt-Jakob Disease with a Variety of Visual Symptoms: A Case Report with Autopsy Study. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e938654. [PMID: 36905109 PMCID: PMC10015505 DOI: 10.12659/ajcr.938654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Sporadic Creutzfeldt-Jakob disease (sCJD) is a fatal disease caused by the change of prion protein (PrP). Affected patients present with rapidly progressive cognitive dysfunction, myoclonus, or akinetic mutism. Diagnosing the Heidenhain variant of sCJD, which initially causes various visual symptoms, can be particularly difficult. CASE REPORT A 72-year-old woman presented with a 2- to 3-month history of photophobia, blurring vision in both eyes. Seven days previously, she showed visual impairment of 20/2000 in both eyes. Left homonymous hemianopia and restricted downward movement of the left eye were observed with an intact pupillary light reflex and normal fundoscopy. On admission, her visual acuity was light perception. Cranial magnetic resonance imaging revealed no abnormality, and electroencephalography showed no periodic synchronous discharges. Cerebrospinal fluid examination on the sixth hospital day revealed tau and 14-3-3 protein with a positive result of real-time quaking-induced conversion. She thereafter developed myoclonus and akinetic mutism and died. Autopsy revealed thinning and spongiform change of the cerebral cortex of the right occipital lobe. Immunostaining showed synaptic-type deposits of abnormal PrP and hypertrophic astrocytes. Consequently, she was diagnosed with the Heidenhain variant of sCJD with both methionine/methionine type 1 and type 2 cortical form based on the western blot of cerebral tissue and PrP gene codon 129 polymorphism. CONCLUSIONS When a patient presents with various progressive visual symptoms, even without typical findings of electroencephalography or cranial magnetic resonance imaging, it is essential to suspect the Heidenhain variant of sCJD and perform appropriate cerebrospinal fluid tests.
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Affiliation(s)
- Yoshio Hisata
- Department of General Medicine, Saga University Hospital, Saga, Japan.,Department of Internal Medicine, Nagahama City Kohoku Hospital, Nagahama, Shiga, Japan
| | - Shun Yamashita
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Motoi Yoshimura
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Tomoyo M Nishi
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Yoshimasa Oda
- Department of General Medicine, Yuai-Kai Foundation & Oda Hospital, Kashima, Saga, Japan
| | - Hiroyuki Honda
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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8
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Ng JKY, Xie PJ, Saber A, Huxtable J. Assessment of photopsia (flashing lights). BMJ 2023; 380:e064767. [PMID: 36690353 DOI: 10.1136/bmj-2021-064767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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9
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Reduplicative paramnesia as an atypical form of presentation of a Heidenhain variant of Creutzfeldt-Jakob disease: A case report. J Int Neuropsychol Soc 2022:1-5. [PMID: 36062534 DOI: 10.1017/s1355617722000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A previously healthy woman began to present recurrent episodes of reduplicative paramnesia within her home and later structured visual hallucinations. The case was initially oriented as an incipient vascular dementia. Detailed anamnesis and neuropsychological examination suggested a rapidly progressive pattern of neuropsychological deficits mostly attributable to parieto-occipital disturbances with some component of fronto-temporal involvement. Subsequently, cerebellar symptoms were added. Although the initial imaging studies were inconclusive, the MRI performed during follow-up showed a series of findings compatible with a prion disease. Based on the neuropsychological and clinical features and the imaging pattern, the diagnosis of Heidenhain Variant of Creutzfeldt-Jakob disease was established. This is the first report of a Heidenhain Variant of Creutzfeldt-Jakob disease presenting as a reduplicative paramnesia as the first manifestation of this disease.
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10
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Goodwill VS, Dryden I, Choi J, De Lillo C, Soldau K, Llibre-Guerra J, Sanchez H, Sigurdson CJ, Lin JH. Minimal change prion retinopathy: Morphometric comparison of retinal and brain prion deposits in Creutzfeldt-Jakob disease. Exp Eye Res 2022; 222:109172. [PMID: 35803332 PMCID: PMC9946801 DOI: 10.1016/j.exer.2022.109172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023]
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is the most commonly diagnosed human prion disease caused by the abnormal misfolding of the 'cellular' prion protein (PrPC) into the transmissible 'scrapie-type' prion form (PrPSc). Neuropathologic evaluation of brains with sCJD reveals abnormal PrPSc deposits primarily in grey matter structures, often associated with micro-vacuolar spongiform changes in neuropil, neuronal loss, and gliosis. Abnormal PrPSc deposits have also been reported in the retina of patients with sCJD, but few studies have characterized the morphology of these retinal PrPSc deposits or evaluated for any retinal neurodegenerative changes. We performed histopathologic and morphometric analyses of retinal and brain prion deposits in 14 patients with sCJD. Interestingly, we discovered that the morphology of retinal PrPSc deposits generally differs from that of brain PrPSc deposits in terms of size and shape. We found that retinal PrPSc deposits consistently localize to the outer plexiform layer of the retina. Additionally, we observed that the retinal PrPSc deposits are not associated with the spongiform change, neuronal loss, and gliosis often seen in the brain. The stereotypic morphology and location of PrPSc deposits in sCJD retinas may help guide the use of ocular imaging devices in the detection of these deposits for a clinical diagnosis.
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Affiliation(s)
- Vanessa S Goodwill
- Department of Pathology, University of California, San Diego, CA, 92093, USA.
| | - Ian Dryden
- Departments of Pathology and Ophthalmology, Stanford University, CA, 94305, USA; VA Palo Alto Healthcare System, Palo Alto, CA, 94304, USA
| | - Jihee Choi
- Departments of Pathology and Ophthalmology, Stanford University, CA, 94305, USA; VA Palo Alto Healthcare System, Palo Alto, CA, 94304, USA
| | - Chiara De Lillo
- Departments of Pathology and Ophthalmology, Stanford University, CA, 94305, USA
| | - Katrin Soldau
- Department of Pathology, University of California, San Diego, CA, 92093, USA
| | - Jorge Llibre-Guerra
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63108, USA; Global Brain Health Institute, University of California, San Francisco, CA, 94143, USA
| | - Henry Sanchez
- Department of Neurology, University of California, San Francisco, CA, 94143, USA
| | | | - Jonathan H Lin
- Departments of Pathology and Ophthalmology, Stanford University, CA, 94305, USA; VA Palo Alto Healthcare System, Palo Alto, CA, 94304, USA.
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11
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Case Report: A Case of Creutzfeldt–Jakob Heidenhain Variant Simulating PRES. Diagnostics (Basel) 2022; 12:diagnostics12071558. [PMID: 35885464 PMCID: PMC9318170 DOI: 10.3390/diagnostics12071558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 12/02/2022] Open
Abstract
The Heidenhain Variant of Creutzfeldt–Jakob disease (CJD) is an uncommon early clinical syndrome of the otherwise regular sporadic CJD, which belongs to the group of prion diseases caused by a transmissible agent, the misfolded form of the prion protein. The most characteristic symptoms of CJD are rapidly progressive cognitive impairment, typical motor manifestations and mental and behavioural changes. Conversely, in the Heidenhain Variant, different kinds of visual disturbances are observed at onset due to microvacuolar spongiform degeneration or, less frequently, confluent spongiform changes in the parieto-occipital area, detectable through brain MRI with hyperintensity in T2-FLAIR or DWI in the same areas. Since this an extremely rare condition with a heterogeneous clinical presentation, it may easily be misdiagnosed with other diseases at the earlier stages. Here, we describe the case of a patient initially diagnosed with posterior reversible encephalopathy syndrome (PRES), presenting with visual disturbances and headache at onset in a context of poorly controlled arterial hypertension. Subsequently, a rapid worsening of cognitive decline, associated with myoclonus and startle reaction led to further investigations, shifting the diagnosis toward a rapidly evolving neurodegenerative form. This hypothesis was also supported by EEG traces, MRI and CSF analysis. Finally, the clinical–instrumental evolution confirmed the diagnosis of Heidenhain Variant of CJD.
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12
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Nihat A, Mok TH, Odd H, Thompson AGB, Caine D, McNiven K, O'Donnell V, Tesfamichael S, Rudge P, Collinge J, Mead S. Development of novel clinical examination scales for the measurement of disease severity in Creutzfeldt-Jakob disease. J Neurol Neurosurg Psychiatry 2022; 93:404-412. [PMID: 35022318 PMCID: PMC8921594 DOI: 10.1136/jnnp-2021-327722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To use a robust statistical methodology to develop and validate clinical rating scales quantifying longitudinal motor and cognitive dysfunction in sporadic Creutzfeldt-Jakob disease (sCJD) at the bedside. METHODS Rasch analysis was used to iteratively construct interval scales measuring composite cognitive and motor dysfunction from pooled bedside neurocognitive examinations collected as part of the prospective National Prion Monitoring Cohort study, October 2008-December 2016.A longitudinal clinical examination dataset constructed from 528 patients with sCJD, comprising 1030 Motor Scale and 757 Cognitive Scale scores over 130 patient-years of study, was used to demonstrate scale utility. RESULTS The Rasch-derived Motor Scale consists of 8 items, including assessments reliant on pyramidal, extrapyramidal and cerebellar systems. The Cognitive Scale comprises 6 items, and includes measures of executive function, language, visual perception and memory. Both scales are unidimensional, perform independently of age or gender and have excellent inter-rater reliability. They can be completed in minutes at the bedside, as part of a normal neurocognitive examination. A composite Examination Scale can be derived by averaging both scores. Several scale uses, in measuring longitudinal change, prognosis and phenotypic heterogeneity are illustrated. CONCLUSIONS These two novel sCJD Motor and Cognitive Scales and the composite Examination Scale should prove useful to objectively measure phenotypic and clinical change in future clinical trials and for patient stratification. This statistical approach can help to overcome obstacles to assessing clinical change in rapidly progressive, multisystem conditions with limited longitudinal follow-up.
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Affiliation(s)
- Akin Nihat
- UCL Institute of Prion Diseases, MRC Prion Unit at UCL, London, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Tze How Mok
- UCL Institute of Prion Diseases, MRC Prion Unit at UCL, London, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Hans Odd
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Andrew Geoffrey Bourne Thompson
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Diana Caine
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Kirsty McNiven
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Veronica O'Donnell
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Selam Tesfamichael
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Peter Rudge
- UCL Institute of Prion Diseases, MRC Prion Unit at UCL, London, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - John Collinge
- UCL Institute of Prion Diseases, MRC Prion Unit at UCL, London, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Simon Mead
- UCL Institute of Prion Diseases, MRC Prion Unit at UCL, London, UK .,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
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13
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Corriveau-Lecavalier N, Li W, Ramanan VK, Drubach DA, Day GS, Jones DT. Three cases of Creutzfeldt-Jakob disease presenting with a predominant dysexecutive syndrome. J Neurol 2022; 269:4222-4228. [PMID: 35233692 PMCID: PMC9516260 DOI: 10.1007/s00415-022-11045-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
Abstract
Creutzfeldt-Jakob disease (CJD) is a rare, uniformly fatal prion disease. Although CJD commonly presents with rapidly progressive dementia, ataxia, and myoclonus, substantial clinicopathological heterogeneity is observed in clinical practice. Unusual and predominantly cognitive clinical manifestations of CJD mimicking common dementia syndromes are known to pose as an obstacle to early diagnosis and prognosis. We report a series of three patients with probable or definite CJD (one male and two females, ages 52, 58 and 68) who presented to our tertiary behavioral neurology clinic at Mayo Clinic Rochester that met criteria for a newly defined progressive dysexecutive syndrome. Glucose hypometabolism patterns assessed by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) strongly resembled those of dysexecutive variant of Alzheimer's disease (dAD). However, magnetic resonance imaging (MRI) demonstrated restricted diffusion in neocortical areas and deep nuclei, while cerebrospinal fluid biomarkers indicated abnormal levels of 14-3-3, total-tau, and prion seeding activity (RT-QuIC), establishing the diagnosis of CJD. Electroencephalogram (EEG) additionally revealed features previously documented in atypical cases of CJD. This series of clinical cases demonstrates that CJD can present with a predominantly dysexecutive syndrome and FDG-PET hypometabolism typically seen in dAD. This prompts for the need to integrate information on clinical course with multimodal imaging and fluid biomarkers to provide a precise etiology for dementia syndromes. This has important clinical implications for the diagnosis and prognosis of CJD in the context of emerging clinical characterization of progressive dysexecutive syndromes in neurodegenerative diseases like dAD.
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Affiliation(s)
| | - Wentao Li
- Department of Neurology, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
| | - Vijay K Ramanan
- Department of Neurology, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
| | - Daniel A Drubach
- Department of Neurology, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
| | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA. .,Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA.
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14
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Potente E, Pelliccioni P, Rossi T, Sallei M, Rossi R, Parchi P, Pelliccioni G. More Than Meets the Eye: "In Vivo" Diagnosis of Heidenhain Variant of Sporadic Creutzfeldt-Jakob Disease. J Neuroophthalmol 2022; 42:e423-e426. [PMID: 35475857 DOI: 10.1097/wno.0000000000001389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Eleonora Potente
- Neurology Department (EP, TR, GP), IRCCS INRCA, Ancona, Italy ; Eye Clinic (Paolo Pelliccioni), Polytechnic University of Marche, University Hospital "Ospedali Riuniti," Ancona, Italy ; Radiology Unit (MS, RR), IRCCS INRCA, Ancona, Italy ; IRCCS Istituto delle Scienze Neurologiche di Bologna (Piero Parchi), Bologna, Italy; and Department of Experimental, Diagnostic and Specialty Medicine (DIMES) (Piero Parchi), University of Bologna, Bologna, Italy
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15
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Differential Accumulation of Misfolded Prion Strains in Natural Hosts of Prion Diseases. Viruses 2021; 13:v13122453. [PMID: 34960722 PMCID: PMC8706046 DOI: 10.3390/v13122453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 01/01/2023] Open
Abstract
Prion diseases, also known as transmissible spongiform encephalopathies (TSEs), are a group of neurodegenerative protein misfolding diseases that invariably cause death. TSEs occur when the endogenous cellular prion protein (PrPC) misfolds to form the pathological prion protein (PrPSc), which templates further conversion of PrPC to PrPSc, accumulates, and initiates a cascade of pathologic processes in cells and tissues. Different strains of prion disease within a species are thought to arise from the differential misfolding of the prion protein and have different clinical phenotypes. Different strains of prion disease may also result in differential accumulation of PrPSc in brain regions and tissues of natural hosts. Here, we review differential accumulation that occurs in the retinal ganglion cells, cerebellar cortex and white matter, and plexuses of the enteric nervous system in cattle with bovine spongiform encephalopathy, sheep and goats with scrapie, cervids with chronic wasting disease, and humans with prion diseases. By characterizing TSEs in their natural host, we can better understand the pathogenesis of different prion strains. This information is valuable in the pursuit of evaluating and discovering potential biomarkers and therapeutics for prion diseases.
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16
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Khan S, Khan S. Sporadic Creutzfeldt-Jakob Disease: Diagnosing Typical and Atypical Presentations under Limited Circumstances. Dement Geriatr Cogn Disord 2021; 50:36-42. [PMID: 34023835 DOI: 10.1159/000514470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sporadic Creutzfeldt-Jakob disease (sCJD) is a transmissible disorder of the central nervous system caused by the transformation of normal prion protein into an abnormal misfolded form. The process begins spontaneously and runs a vicious cycle to cause spongiform encephalopathy, rapidly resulting in death. Amply described in the western literature, CJD is scarcely reported in Asia due to certain limitations including missed diagnosis, under-reporting, and rarity of the disease. Brain MRI, electroencephalogram, cerebrospinal fluid testing, and biopsy of the infected brain tissue support the diagnosis in cases of clinical suspicion. However, the diagnosis can still be made with limited available resources in developing countries. METHOD A review of CJD cases evaluated in the neurology department of a tertiary care hospital in Pakistan was done from 2002 to 2018. RESULTS Eleven cases labeled as sCJD are identified based on the European MRI-CJD consortium criteria. This is the first study on CJD from Pakistan, which includes both the typical and atypical presentations. CONCLUSION Even with limited testing available, the diagnosis of CJD can be made with confidence in the developing countries, provided the suspicion is kept high in cases of rapid onset dementia and acute behavioral changes.
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Affiliation(s)
- Shazma Khan
- Department of Neurology, Aga Khan University Hospital, Karachi, Pakistan.,Department of Neurology, Ziauddin University Hospital, Karachi, Pakistan
| | - Sara Khan
- Department of Neurology, Aga Khan University Hospital, Karachi, Pakistan
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17
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Escalere M, Joly C, Palisson J, Budowski C, Mongin M, Degos B. Balint's syndrome revealing Creutzfeldt-Jakob disease. Rev Neurol (Paris) 2021; 178:278-280. [PMID: 34274131 DOI: 10.1016/j.neurol.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022]
Affiliation(s)
- M Escalere
- Service de Neurologie, AP-HP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint-Denis, Sorbonne Paris Nord, Bobigny, France
| | - C Joly
- Service de Neurologie, AP-HP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint-Denis, Sorbonne Paris Nord, Bobigny, France
| | - J Palisson
- Service de Neurologie, AP-HP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint-Denis, Sorbonne Paris Nord, Bobigny, France
| | - C Budowski
- Service de Neurologie, AP-HP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint-Denis, Sorbonne Paris Nord, Bobigny, France
| | - M Mongin
- Service de Neurologie, AP-HP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint-Denis, Sorbonne Paris Nord, Bobigny, France
| | - B Degos
- Service de Neurologie, AP-HP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint-Denis, Sorbonne Paris Nord, Bobigny, France; Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/Inserm U1050, Université PSL, 75005 Paris, France.
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18
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Hayashi Y, Kunieda K, Kudo T, Kimura A, Fujishima I, Shimohata T. Long-term preservation of pharyngeal swallowing function in MM2-cortical-type sporadic Creutzfeldt-Jakob disease. Prion 2021; 15:82-86. [PMID: 34078217 PMCID: PMC8183547 DOI: 10.1080/19336896.2021.1930851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Swallowing function in long-term survivors of Creutzfeldt-Jakob disease (CJD) has not been elucidated. Herein, we report a patient with MM2-cortical-type sporadic CJD (MM2C-type sCJD) with long-term preservation of pharyngeal swallowing function using videofluoroscopic (VF) examination of swallowing. A 55-year-old woman was admitted to hospital because of dyscalculia and memory disturbance 3 years after the onset of these symptoms. Neurological examination revealed dementia, extrapyramidal signs, and delusion. Diffusion-weighted MRI revealed bilateral hyperintensity in the basal ganglia and frontal, temporal, and parietal cortices. No mutation with the methionine homozygote at codon 129 was found on PRNP gene analysis. VF was performed 68 months after the onset. Although bolus transport from the oral cavity to the pharynx worsened, the pharyngeal swallowing function was preserved even 68 months after onset. Serial MRI examinations revealed no apparent atrophy of the brainstem. Single photon emission computed tomography revealed that the regional cerebral blood flow in the brainstem was preserved. These findings suggest that pseudobulbar palsy is the pathophysiology underlying dysphagia in long-term survivors of MM2C-type sCJD, probably owing to preserved brainstem function even in a state of akinetic mutism.
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Affiliation(s)
- Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Takuya Kudo
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
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19
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Diagnostic value of diffusion-weighted brain magnetic resonance imaging in patients with sporadic Creutzfeldt-Jakob disease: a systematic review and meta-analysis. Eur Radiol 2021; 31:9073-9085. [PMID: 33982159 DOI: 10.1007/s00330-021-08031-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/14/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the diagnostic yield and performance of DWI in patients with sporadic CJD (sCJD). METHODS A systematic literature search of the MEDLINE and EMBASE databases was performed, since their inception up to July 28, 2020. Pooled diagnostic yield of diffusion-weighted imaging was calculated using DerSimonian-Laird random-effects model. Pooled diagnostic performance of DWI (sensitivity, specificity, and area under the curve) in diagnosing sCJD among patients with rapidly progressive dementia was calculated using a bivariate random-effects model. Subgroup analysis and meta-regression were performed. RESULTS Fifteen original articles with a total of 1144 patients with sCJD were included. The pooled diagnostic yield was 91% (95% confidence interval [CI], 86 to 94%); summary sensitivity, 91% (95% CI, 84 to 95%); and specificity, 97% (95% CI, 94 to 99%). The area under the hierarchical summary receiver operating characteristic curve was 0.99 (95% CI, 0.97-0.99). Simultaneous involvement of the neocortex and striatum was the most common finding, and the neocortex was the most common site to be involved on DWI followed by striatum, thalamus, and cerebellum. Subgroup analysis and meta-regression demonstrated significant heterogeneity among the studies associated with the reference standards used for diagnosis of sCJD. CONCLUSIONS DWI showed excellent diagnostic value in diagnosis of sporadic Creutzfeldt-Jakob disease among patients with rapidly progressive dementia. Simultaneous involvement of the neocortex and striatum was the most common finding, and the neocortex was the most common site to be involved on diffusion-weighted imaging followed by striatum, thalamus, and cerebellum. KEY POINTS • The pooled diagnostic yield of diffusion-weighted imaging in sporadic Creutzfeldt-Jakob disease was 91%. • The diagnostic performance of diffusion-weighted imaging for predicting sporadic Creutzfeldt-Jakob disease among patients with rapidly progressive dementia was excellent, with pooled sensitivity, 91%, and specificity, 97%. • Simultaneous involvement in the neocortex and striatum was most commonly seen on diffusion-weighted imaging (60%), followed by the neocortex without striatum (30%), thalamus (21%), cerebellum (8%), and striatum without neocortex (7%).
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20
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Keh R, Al-Bachari S, Mustafa M, Chatterjee S, Watson N, Pal S, Dayanandan R. Visual misperceptions. Pract Neurol 2021; 21:456-458. [PMID: 33658287 DOI: 10.1136/practneurol-2020-002841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Ryan Keh
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Sarah Al-Bachari
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Mohanned Mustafa
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Somenath Chatterjee
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Neil Watson
- National CJD Research and Surveillance Unit, Edinburgh, UK
| | - Suvankar Pal
- National CJD Research and Surveillance Unit, Edinburgh, UK.,Deanery of Clinical Sciences, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Rejith Dayanandan
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
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21
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Sokhi D, Yakub F, Sharma K, Waa S, Mativo P. Heidenhain Variant of Sporadic Creutzfeldt-Jakob Disease: First Reported Case from East Africa. Int Med Case Rep J 2021; 14:39-44. [PMID: 33564270 PMCID: PMC7866935 DOI: 10.2147/imcrj.s287358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/19/2020] [Indexed: 11/23/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare prion disease that causes rapidly progressive fatal neurodegeneration. The rarer Heidenhain variant of sCJD presents with visual symptoms and is rarely reported in the literature from sub-Saharan Africa. We report the case of a 57-year-old male with a three-week history of losing direction when driving home and visual hallucinations described as seeing rainbows. Magnetic resonance imaging (MRI) of the brain revealed unilateral parieto-occipital sulcal hyperintensities with restriction on diffusion-weighted imaging (DWI), and electroencephalography (EEG) showed right para-central slowing leading to an initial diagnosis of non-convulsive status epilepticus. He was treated with anti-epileptic medication but was re-admitted less than a month later with worsening spatial memory, aggression, ataxia, dysarthria, myoclonic jerks and a positive startle response, later developing generalised tonic-clonic seizures. Repeat MRI brain scan showed widespread posterior-predominant sulcal DWI restriction in a cortical ribboning pattern pathognomonic for sCJD. EEG showed diffuse slowing, and cerebrospinal fluid was analyzed for abnormal prion protein using real-time quaking-induced conversion but was inconclusive due to suboptimal sample collection. The patient fulfilled the diagnostic criteria for probable sCJD, Heidenhain variant; the family declined brain biopsy for definitive diagnosis. He was subsequently palliated at a local hospice where he died approximately three months after the onset of symptoms. Our case highlights the presence of a rare form of sCJD, and the diagnostic challenges faced in our resource-limited setting.
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Affiliation(s)
- Dilraj Sokhi
- Department of Medicine, Aga Khan University Hospital, Aga Khan University Medical College of East Africa, Nairobi, Kenya
| | - Fazal Yakub
- Department of Medicine, Aga Khan University Hospital, Aga Khan University Medical College of East Africa, Nairobi, Kenya
| | - Karishma Sharma
- Department of Medicine, Aga Khan University Hospital, Aga Khan University Medical College of East Africa, Nairobi, Kenya
| | - Sheila Waa
- Department of Radiology, Aga Khan University Hospital, Aga Khan University Medical College of East Africa, Nairobi, Kenya
| | - Peter Mativo
- Department of Medicine, Aga Khan University Hospital, Aga Khan University Medical College of East Africa, Nairobi, Kenya
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22
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Muthusamy S, Garg P, Chandra RV, Seneviratne U. How common are seizures in the heidenhain variant of creutzfeldt-jakob disease? A case report and systematic review. J Clin Neurosci 2021; 86:301-309. [PMID: 33436304 DOI: 10.1016/j.jocn.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/08/2020] [Accepted: 10/03/2020] [Indexed: 11/24/2022]
Abstract
The Heidenhain variant of Creutzfeld-Jakob disease (HvCJD) is a relentlessly progressive and fatal neurodegenerative disorder characterised by prominent visual features early in its clinical course. However, seizures are uncommonly reported in HvCJD. The case history of a patient admitted to our institution with HvCJD and seizures is described followed by a systematic review of the association between HvCJD and seizures. A systematic search of the databases Medline, PubMed, and PsycInfo was conducted, from inception to November 2019, using keywords relating to 'Creutzfeldt-Jakob disease' and 'Heidenhain variant', to ascertain the frequency of seizures in HvCJD, as well as, seizure semiology and electrographic features. The Preferred Items Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in the construction of this systematic review. All studies, including case reports of patients who met the diagnostic criteria for HvCJD where details pertaining to clinical presentation, imaging, biochemical and EEG findings were available were included. There were 46 articles reporting on a total of 73 patients. Seizures occurred in only four out of 73 cases (5.5%). The semiology of these seizures were focal motor seizures with or without secondary generalisation and occipital lobe seizures. Imaging and electrographic findings were most commonly abnormal in the posterior cerebral cortices (in particular the occipital and occipito-parietal regions). This systematic review suggests that seizures are uncommon in HvCJD despite the frequency of imaging and electrographic abnormalities in the posterior cerebral regions. A key limitation of this systematic review is the variability of publications in terms of incomplete reporting of clinical data, in particular potential under-reporting of seizures, as well as follow up, which may have contributed to the lower frequency of seizures reported in patients with HvCJD.
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Affiliation(s)
| | - Priya Garg
- Middlemore Hospital, Auckland, New Zealand
| | - Ronil V Chandra
- School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Melbourne, Victoria, Australia; Neuroradiology Service, Monash Imaging, Monash Medical Centre, Clayton, Melbourne, Australia.
| | - Udaya Seneviratne
- Department of Neurology, Monash Medical Centre, Clayton, Melbourne, Australia; School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Melbourne, Victoria, Australia; Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
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23
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Freitas CS, Pinheiro MGM, Fonte EJD, Hazin AN, Smid J, Barbosa BJAP. Posterior cortical ribboning in the Heidenhain variant of Creutzfeldt-Jakob Disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:241. [PMID: 32321050 DOI: 10.1590/0004-282x20190176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/20/2019] [Indexed: 11/21/2022]
Affiliation(s)
| | | | | | | | - Jerusa Smid
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil
| | - Breno José Alencar Pires Barbosa
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife PE, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil
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24
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Sundaram SE, Staffaroni AM, Walker NC, Casaletto KB, Casey M, Golubjatnikov A, Metcalf S, O’Leary K, Wong K, Benisano K, Forner S, Gonzalez Catalan M, Allen IE, Rosen HJ, Kramer JH, Geschwind MD. Baseline neuropsychological profiles in prion disease predict survival time. Ann Clin Transl Neurol 2020; 7:1535-1545. [PMID: 33314770 PMCID: PMC7480924 DOI: 10.1002/acn3.51115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Few studies have captured the neuropsychological profile of sporadic Creutzfeldt-Jakob disease (sCJD) with neuropsychological testing, and little is known about cognitive predictors of survival. We characterized baseline neuropsychological performance in sCJD and investigated associations with survival. METHODS sCJD participants who completed the MMSE (n = 118), 61 sCJD of whom also completed a neuropsychological battery at baseline, and 135 age-matched healthy controls, were included. Composite scores of global cognition, memory, executive functions, visuospatial, and language were derived. Cox proportional hazard models estimated survival time, controlling for age and education. Additional models adjusted for Barthel Index and PRNP codon 129 polymorphism. RESULTS sCJD participants performed significantly worse than controls on all cognitive tasks and composites with most showing very large effect sizes. The three tests showing the largest group differences were delayed verbal recall (Hedges'g = 4.08, P < 0.0001), Stroop Inhibition (Hedges'g = 3.14, P < 0.0001), and Modified Trails (Hedges'g = 2.94, P < 0.0001). Memory (95%) and executive functioning (87%) composites were most commonly impaired. Poorer global (HR = 0.65, P < 0.0001), visuospatial (HR = 0.82, P < 0.0001), and memory (HR = 0.82, P = 0.01) composites predicted shorter survival. Visuospatial cognition remained a significant predictor even after adjusting for all other cognitive composites; each standard deviation decrease in visuospatial cognition was associated with an 18% higher chance of death (HR = 0.82, P < 0.003). Global (HR = 0.68, P = 0.03) and visuospatial (HR = 0.82, P = 0.001) composites remained significant predictors after controlling for Barthel Index and codon 129. INTERPRETATION sCJD participants exhibit a broad range of cognitive impairments, with memory and executive functioning deficits in the vast majority. Neuropsychological assessment, particularly of visuospatial abilities, informs prognostication in sCJD.
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Affiliation(s)
- Saranya E. Sundaram
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
- Department of PsychologyPalo Alto UniversityPalo AltoCalifornia
| | - Adam M. Staffaroni
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Nicole C. Walker
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
- Department of PsychologyCalifornia School of Professional PsychologyAlliant International UniversitySan FranciscoCalifornia
| | - Kaitlin B. Casaletto
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Megan Casey
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Aili Golubjatnikov
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Stacy Metcalf
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Kelly O’Leary
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Katherine Wong
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Kendra Benisano
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Sven Forner
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Marta Gonzalez Catalan
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
- Department of PsychologyPalo Alto UniversityPalo AltoCalifornia
| | - Isabel E. Allen
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCalifornia
| | - Howard J. Rosen
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Michael D. Geschwind
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
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25
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Matsubayashi T, Akaza M, Hayashi Y, Hamaguchi T, Yamada M, Shimohata T, Yokota T, Sanjo N. Focal sharp waves are a specific early-stage marker of the MM2-cortical form of sporadic Creutzfeldt-Jakob disease. Prion 2020; 14:207-213. [PMID: 32787547 PMCID: PMC7518755 DOI: 10.1080/19336896.2020.1803516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Periodic sharp wave complexes (PSWCs), identified using electroencephalography, are observed in less than half of patients with the methionine homozygosity type 2 cortical (MM2c) form of sporadic Creutzfeldt-Jakob disease (sCJD), and only at a later stage of the disease. In this study, we identified early and specific markers on the electroencephalograms (EEGs) of patients with MM2c-sCJD. We retrospectively investigated the clinical records, EEGs, and magnetic resonance imaging (MRI) scans of patients diagnosed with sCJD and compared the EEG findings of MM2c-sCJD and MM1/classic sCJD groups. The records of six patients with MM2c-sCJD and eight with MM1/classic sCJD were included. The median ages of onset in the MM2c- and MM1/classic sCJD groups were 75.0 (range, 60–83) and 72.5 (range, 51–74) years, respectively, and the average durations between disease onset and the first EEG were 9.17 (range, 4–15) and 1.88 (range, 1–4) months, respectively. Focal sharp waves and/or focal spike-and-wave complexes in the brain regions corresponding with cortical hyperintensities on MRI scans were identified on the EEGs of patients with MM2c-sCJD in the early stages of disease progression. In contrast, EEGs of patients in the early stages of MM1/classic sCJD showed lateralized or generalized diffuse sharp waves and spike-and-wave complexes, which were not limited to cortical hyperintensities identified with MRI scans. Our findings indicate that focal sharp waves and/or focal spike-and-wave complexes on the EEGs of patients in the early phase of MM2c-sCJD are characteristic of the disease, suggesting the possible usefulness of this characteristic for early diagnosis.
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Affiliation(s)
- Taiki Matsubayashi
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences , Tokyo, Japan
| | - Miho Akaza
- Respiratory and Nervous System Science, Biomedical Laboratory Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo, Japan
| | - Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine , Gifu, Japan
| | - Tsuyoshi Hamaguchi
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science , Kanazawa, Japan
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science , Kanazawa, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine , Gifu, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences , Tokyo, Japan
| | - Nobuo Sanjo
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences , Tokyo, Japan
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26
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Abbadessa G, Lavorgna L, Miele G, Cirillo M, Bonavita S. Heidenhain variant of Creutzefeldt-Jackob disease in a patient carrying the V210I mutation with asymmetric MRI abnormalities. Acta Neurol Belg 2020; 120:1007-1009. [PMID: 32436078 DOI: 10.1007/s13760-020-01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
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27
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Wu X, Cui Z, Guomin X, Wang H, Zhang X, Li Z, Sun Q, Qi F. Rare genetic E196A mutation in a patient with Creutzfeldt-Jakob disease: a case report and literature. Prion 2020; 14:143-148. [PMID: 32501129 PMCID: PMC7518748 DOI: 10.1080/19336896.2020.1769528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Genetic Creutzfeldt–Jakob disease (gCJD) is characterized by mutations in the PRNP gene and represents approximately 10–15% of the human prion diseases. Here, we report a 42-year-old Chinese man who was diagnosed with gCJD. The patient had a rare mutation in codon 196 (E196A) of PRNP leading to an exchange of amino acid from glutamic acid (E) to alanine (A). The polymorphism of codon 129 in the patient was methionine homozygote. His mother and daughter are asymptomatic carriers of the same mutation. The clinical manifestations were similar to those of sporadic CJD. 14-3-3 protein was positive in cerebrospinal fluid, and there were sharp slow complex waves in electroencephalography and ribbon-like signals on magnetic resonance imaging (MRI). The main complaints of patient changed from visual space and visual colour to psychotic symptoms with enhanced high signal intensity on the occipital and frontal cortices on MRI. We compared the clinical characteristics of the current patient with those of previously reported Chinese patients with other gCJD of E196A mutation to summarize the common features of E196A gCJD.
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Affiliation(s)
- Xiping Wu
- Department of Neurology, Ningbo Medical Center Li-Huili Hospital , Ningbo, China
| | - Zhao Cui
- Department of Neurology, Ningbo Medical Center Li-Huili Hospital , Ningbo, China
| | - Xie Guomin
- Department of Neurology, Ningbo Medical Center Li-Huili Hospital , Ningbo, China
| | - Haifeng Wang
- Department of Neurology, Ningbo Medical Center Li-Huili Hospital , Ningbo, China
| | - Xiaoling Zhang
- Department of Neurology, Ningbo Medical Center Li-Huili Hospital , Ningbo, China
| | - Zhiguang Li
- Department of Neurology, Ningbo Medical Center Li-Huili Hospital , Ningbo, China
| | - Qi Sun
- Department of Neurology, Ningbo Medical Center Li-Huili Hospital , Ningbo, China
| | - Feiteng Qi
- Department of Neurology, Ningbo Medical Center Li-Huili Hospital , Ningbo, China
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Cai S, Yordi SF, Henderson AD. Homonymous Hemianopia With Normal Magnetic Resonance Imaging. JAMA Ophthalmol 2020; 138:702-703. [DOI: 10.1001/jamaophthalmol.2020.0447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sophie Cai
- Wilmer Eye Institute, Division of Neuro-Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Ophthalmology, Duke Eye Center, Durham, North Carolina
| | - Sari F. Yordi
- Wilmer Eye Institute, Division of Neuro-Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Amanda D. Henderson
- Wilmer Eye Institute, Division of Neuro-Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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29
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Katsikaki G, Dagklis IE, Angelopoulos P, Ntantos D, Prevezianou A, Bostantjopoulou S. Atypical and early symptoms of sporadic Creutzfeldt – Jakob disease: case series and review of the literature. Int J Neurosci 2020; 131:927-938. [DOI: 10.1080/00207454.2020.1759594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Grammatiki Katsikaki
- 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Ioannis E. Dagklis
- 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Petros Angelopoulos
- 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Dimitrios Ntantos
- 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Angeliki Prevezianou
- 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Sevasti Bostantjopoulou
- 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
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30
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Hayashi Y, Iwasaki Y, Waza M, Shibata H, Akagi A, Kimura A, Inuzuka T, Satoh K, Kitamoto T, Yoshida M, Shimohata T. Clinicopathological findings of an MM2-cortical-type sporadic Creutzfeldt-Jakob disease patient with cortical blindness during a course of glaucoma and age-related macular degeneration. Prion 2020; 13:124-131. [PMID: 31219399 PMCID: PMC6629179 DOI: 10.1080/19336896.2019.1631680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Here, we report an autopsy-verified patient with MM2-coritical-type sporadic Creutzfeldt-Jakob disease (MM2C-type sCJD) presenting cortical blindness during a course of glaucoma and age-related macular degeneration, and focus on the difficulties involved in early clinical diagnosis. An 83-year-old man was admitted to our hospital 15 months after the onset of cortical blindness, and 9 months after the onset of progressive dementia. Neurological examination revealed dementia, frontal signs, visual disturbance, dysphagia, myoclonus and exaggerated tendon reflexes in the four extremities. Diffusion-weighted MRI (DW-MRI) showed cortical hyperintensities predominantly in the bilateral occipital lobes. PRNP gene analysis showed no mutations with methionine homozygosity at codon 129. Cerebrospinal fluid (CSF) examination revealed elevation of 14–3-3 and total tau protein. The symptoms progressed gradually, and the patient died of aspiration pneumonia, 30 months after the onset. Neuropathological examination revealed extensive large confluent vacuole-type spongiform changes in the cerebral cortices. Prion protein (PrP) immunostaining showed perivascular and plaque-type PrP deposits. We diagnosed our patient as MM2C-type sCJD. There are two difficulties in the early clinical diagnosis of MM2C-type sCJD with ocular disease in the elderly; delayed utilization of DW-MRI, and accompaniment of ocular disease. For early diagnosis of MM2C-type sCJD, we conclude that clinician should perform DW-MRI for patients with isolated dementia or cortical visual disturbance.
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Affiliation(s)
- Yuichi Hayashi
- a Department of Neurology , Gifu University Graduate School of Medicine , Gifu , Japan
| | - Yasushi Iwasaki
- b Autopsy Center of Prion Disease , Institute for Medical Sciences of Aging, Aichi Medical University , Nagakute , Japan
| | - Masahiro Waza
- c Department of Neurology , Kakamigahara Rehabilitation Hospital , Kakamigahara , Japan
| | - Hideaki Shibata
- a Department of Neurology , Gifu University Graduate School of Medicine , Gifu , Japan
| | - Akio Akagi
- b Autopsy Center of Prion Disease , Institute for Medical Sciences of Aging, Aichi Medical University , Nagakute , Japan
| | - Akio Kimura
- a Department of Neurology , Gifu University Graduate School of Medicine , Gifu , Japan
| | - Takashi Inuzuka
- a Department of Neurology , Gifu University Graduate School of Medicine , Gifu , Japan.,d Department of Neurology , Gifu Municipal Hospital , Gifu , Japan
| | - Katsuya Satoh
- e Department of Locomotive Rehabilitation Sciences , Nagasaki University Graduate School of Medicine , Nagasaki , Japan
| | - Tetsuyuki Kitamoto
- f Division of CJD Science and Technology, Department of Prion Research , Center for Translational and Advanced Animal Research on Human Diseases, Tohoku University School of Medicine , Sendai , Japan
| | - Mari Yoshida
- b Autopsy Center of Prion Disease , Institute for Medical Sciences of Aging, Aichi Medical University , Nagakute , Japan
| | - Takayoshi Shimohata
- a Department of Neurology , Gifu University Graduate School of Medicine , Gifu , Japan
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Hallucinatory palinopsia and paroxysmal oscillopsia as initial manifestations of sporadic Creutzfeldt-Jakob disease: A case study. Cortex 2020; 124:188-192. [PMID: 31901708 DOI: 10.1016/j.cortex.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/09/2019] [Accepted: 11/14/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Heidenhain variant of Cruetzfeldt Jacob Disease is a rare phenotype of the disease. Early and isolated visual symptoms characterize this particular variant of CJD. Other typical symptoms pertaining to muti-axial neurological involvement usually appear in following weeks to months. Commonly reported visual difficulties in Heidenhain variant are visual dimness, restricted field of vision, agnosias and spatial difficulties. We report here a case of Heidenhain variant that presented with very unusual symptoms of palinopsia and oscillopsia. CASE PRESENTATION A 62-year-old male patient presented with symptoms of prolonged afterimages following removal of visual stimulus. It was later on accompanied by intermittent sense of unstable visual scene. He underwent surgery in suspicion of cataratcogenous vision loss but with no improvement in symptoms. Additionally he developed symptoms of cerebellar ataxia, cognitive decline and multifocal myoclonus in subsequent weeks. On the basis of suggestive MRI findings in brain, typical EEG changes and a positive result of 14-3-3 protein in CSF, he was eventually diagnosed as sCJD. CONCLUSION This case adds to the tally of handful reports of Heidenhain variant CJD in literature, particularly from India. Two atypical initial symptoms, namely hallucinatory palinopsia and paroxysmal oscillopsia were observed in the index case. Possible explanations of such phenomena in CJD have been explored in light of the available studies.
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Obergassel J, Lohmann L, Meuth SG, Wiendl H, Grauer O, Nelke C. An enigmatic case of cortical anopsia: Antemortem diagnosis of a 14-3-3 negative Heidenhain-variant MM1-sCJD. Prion 2019; 14:24-28. [PMID: 31880189 PMCID: PMC6959312 DOI: 10.1080/19336896.2019.1706703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease is the predominant type of human prion disease. While routine diagnostic in phenotypic cases has advanced considerably, the clinical heterogeneity and rarity of subtypes continue to constitute a major clinical and diagnostic challenge. Here, we report a peculiar case of the Heidenhain-variant of MM1 sporadic Creutzfeldt-Jakob disease presenting as a stroke mimic in an 81-year-old patient with a rapid and clinically distinct course of disease as compared to previously reported cases. While 14-3-3 protein was negative, clinical findings substantiated by 18F-FDG-PET imaging and RT-QuIC-Assay were able to establish the diagnosis. We conclude that in cases presenting with rapid progressive dementia secondary to sudden cortical anopsia the Heidenhain-variant of CJD should be considered.
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Affiliation(s)
- Julius Obergassel
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Lisa Lohmann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Oliver Grauer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Christopher Nelke
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
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33
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Restrepo-Martínez M, Chacón-González J, Oñate-Cadena N, Bayliss L. Neuropsychiatric symptoms in the Heidenhain variant of Creutzfeldt-Jakob's disease mistaken for major depression and functional neurological disorder. Aust N Z J Psychiatry 2019; 53:1222-1223. [PMID: 31113209 DOI: 10.1177/0004867419850319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Miguel Restrepo-Martínez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Jacobo Chacón-González
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Nelcy Oñate-Cadena
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Leo Bayliss
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico.,Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
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34
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Familial Creutzfeldt-Jakob Disease with a PRNP Mutation at Codon 180 Presented with Visual Hallucinations and Illusions. Dement Neurocogn Disord 2019; 18:105-107. [PMID: 31681445 PMCID: PMC6819671 DOI: 10.12779/dnd.2019.18.3.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/06/2019] [Accepted: 10/20/2019] [Indexed: 11/30/2022] Open
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35
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Baiardi S, Capellari S, Bartoletti Stella A, Parchi P. Unusual Clinical Presentations Challenging the Early Clinical Diagnosis of Creutzfeldt-Jakob Disease. J Alzheimers Dis 2019; 64:1051-1065. [PMID: 30010123 DOI: 10.3233/jad-180123] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The introduction of prion RT-QuIC, an ultrasensitive specific assay for the in vivo detection of the abnormal prion protein, has significantly increased the potential for an early and accurate clinical diagnosis of Creutzfeldt-Jakob disease (CJD). However, in the clinical setting, the early identification of patients with possible CJD is often challenging. Indeed, CJD patients may present with isolated symptoms that remain the only clinical manifestation for some time, or with neurological syndromes atypical for CJD. To enhance awareness of unusual disease presentations and promote earlier diagnosis, we reviewed the entire spectrum of atypical early manifestations of CJD, mainly reported to date as case descriptions or small case series. They included sensory either visual or auditory disturbances, seizures, isolated psychiatric manifestations, atypical parkinsonian syndromes (corticobasal syndrome, progressive supranuclear palsy-like), pseudobulbar syndrome, isolated involuntary movements (dystonia, myoclonus, chorea, blepharospasm), acute or subacute onsets mimicking a stroke, isolated aphasia, and neuropathy. Since CJD is a rare disease and its clinical course rapidly progressive, an in-depth understanding and awareness of early clinical features are mandatory to enhance the overall diagnostic accuracy in its very early stages and to recruit optimal candidates for future therapeutic trials.
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Affiliation(s)
- Simone Baiardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences, Bologna, Italy
| | | | - Piero Parchi
- IRCCS Institute of Neurological Sciences, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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36
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Muniz BC, Makita LS, Ribeiro BNDF, Marchiori E. The Heidenhain variant of Creutzfeldt-Jakob disease. Radiol Bras 2019; 52:199-200. [PMID: 31210697 PMCID: PMC6561368 DOI: 10.1590/0100-3984.2017.0166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Bernardo Carvalho Muniz
- Instituto Estadual do Cérebro Paulo Niemeyer - Departamento de Radiologia, Rio de Janeiro, RJ, Brazil
| | - Lana Sayuri Makita
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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37
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Chen BS, Lance S, Lallu B, Anderson NE. Visual snow: Not so benign. J Clin Neurosci 2019; 64:37-39. [DOI: 10.1016/j.jocn.2019.03.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/11/2019] [Indexed: 11/25/2022]
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38
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Naarden T, Ter Meulen BC, van der Weele SI, Blom JD. Alice in Wonderland Syndrome as a Presenting Manifestation of Creutzfeldt-Jakob Disease. Front Neurol 2019; 10:473. [PMID: 31143156 PMCID: PMC6521793 DOI: 10.3389/fneur.2019.00473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Alice in Wonderland syndrome (AIWS) is a rare neurological disorder characterized by distortions of visual perception (metamorphopsias), the body image, and the experience of time, along with derealization and depersonalization. Some 85% of patients present with perceptual distortions in a single sensory modality, e.g., only visual or only somesthetic in nature. Moreover, the majority experience only a single type of distortion, e.g., only micropsia or only macropsia. AIWS has many different etiologies, and hence an extensive differential diagnosis. Its amenability to treatment depends on the underlying pathological process, which in children is mostly encephalitis, and in adults, migraine. In the literature, no more than 180 “clinical” cases of AIWS have been described (i.e., cases in need of medical attention). Of them, some 50% showed a favorable prognosis. However, non-clinical cases (i.e., fleeting, transient cases of AIWS for which no professional help is needed) have been described in up to 30% of the general population. This indicates that AIWS is perhaps not as rare as traditionally assumed, and has led some authors to conclude that, prognostically, AIWS is usually harmless. Methods: From our own clinical practice, we describe the first known case of Creutzfeldt-Jakob Disease (CJD, Heidenhain variant) that presented with symptoms of AIWS. Results: In our patient, disease onset was sudden and rapidly progressive, starting with isolated visual symptoms. Symptoms of AIWS comprised akinetopsia, chloropsia, micropsia, macropsia, zoom vision, and time distortions (quick-motion phenomenon and protracted duration). Soon, these were complicated by paraesthesias, gait instability, aphasia, expressive amusia, cognitive decline, and behavioral changes in the form of agitation and emotional lability. The diagnosis of probable sporadic CJD was confirmed with the aid of a head MRI and cerebrospinal fluid (14-3-3 protein). In the absence of any treatment options, our patient was discharged home and died within 2 months after his visual symptoms had begun. Autopsy consent was not obtained. Conclusion: We conclude that AIWS is not always as harmless as sometimes suggested, and that CJD, although extremely rare, must be part of its extensive differential diagnosis, notably in the presence of rapid cognitive decline.
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Affiliation(s)
- Tirza Naarden
- Department of Neurology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Bastiaan C Ter Meulen
- Department of Neurology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands.,Department of Neurology, Zaans Medisch Centrum, Zaandam, Netherlands
| | | | - Jan Dirk Blom
- Outpatient Clinic for Uncommon Psychiatric Syndromes, Parnassia Psychiatric Institute, The Hague, Netherlands.,Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Department of Psychiatry, University of Groningen, Groningen, Netherlands
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39
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Krüger S, Larsen J, Schaumberg J. [Sporadic Creutzfeldt-Jakob disease imitates posterior reversible encephalopathy syndrome]. DER NERVENARZT 2019; 90:618-622. [PMID: 30840102 DOI: 10.1007/s00115-019-0679-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Schulamith Krüger
- Abteilung für Neurologie, Helios Klinikum Uelzen, Hagenskamp 34, 29525, Uelzen, Deutschland.
| | - Jörg Larsen
- Radiologie und Neuroradiologie, Helios Klinikum Uelzen, Uelzen, Deutschland
| | - Jens Schaumberg
- Abteilung für Neurologie, Helios Klinikum Uelzen, Hagenskamp 34, 29525, Uelzen, Deutschland
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40
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Hsiao PS, Lee YM, Chu FS, Lee CL, Liu FC, Tsai PH. Probable sporadic Creutzfeldt-Jakob disease mimicking focal epilepsy. EPILEPSY & BEHAVIOR CASE REPORTS 2019; 11:77-80. [PMID: 30788213 PMCID: PMC6369248 DOI: 10.1016/j.ebcr.2019.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 11/20/2022]
Abstract
Creutzfeldt-Jakob disease (CJD) presents with seizures as an early symptom in only approximately 3% of cases. These seizures often present as nonconvulsive status epilepticus (NCSE) or epilepsia partialis continua (EPC). Here, we describe a case of probable sporadic CJD (sCJD) in an 83-year-old man whose manifest an unusual presentation of left-hand tonic seizures without evolution to EPC, as well as brain MRI findings interpreted as peri-ictal changes, which led to an initial misdiagnosis of focal epilepsy.
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Affiliation(s)
- Pei-Shan Hsiao
- Department of Laboratory Medicine, National Yang-Ming University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan
- Division of Neurology, Department of Internal Medicine, National Yang-Ming University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan
| | - Yuan-Ming Lee
- Department of Laboratory Medicine, National Yang-Ming University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan
| | - Fu-Sin Chu
- Division of Neurology, Department of Internal Medicine, National Yang-Ming University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan
- Center for Dementia Care and Evolution, National Yang-Ming University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan
| | - Chao-Lin Lee
- Division of Neurology, Department of Internal Medicine, National Yang-Ming University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan
- Center for Dementia Care and Evolution, National Yang-Ming University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan
| | - Fang-Chun Liu
- Division of Neurology, Department of Internal Medicine, National Yang-Ming University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan
- Center for Dementia Care and Evolution, National Yang-Ming University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan
| | - Ping-Huang Tsai
- Division of Neurology, Department of Internal Medicine, National Yang-Ming University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan
- Center for Dementia Care and Evolution, National Yang-Ming University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan
- Department of Neurology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei 112, Taiwan
- Corresponding author at: Division of Neurology, Department of Internal Medicine, National Yang-Ming University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan.
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41
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Baiardi S, Rossi M, Capellari S, Parchi P. Recent advances in the histo-molecular pathology of human prion disease. Brain Pathol 2019; 29:278-300. [PMID: 30588685 DOI: 10.1111/bpa.12695] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023] Open
Abstract
Prion diseases are progressive neurodegenerative disorders affecting humans and other mammalian species. The term prion, originally put forward to propose the concept that a protein could be infectious, refers to PrPSc , a misfolded isoform of the cellular prion protein (PrPC ) that represents the pathogenetic hallmark of these disorders. The discovery that other proteins characterized by misfolding and seeded aggregation can spread from cell to cell, similarly to PrPSc , has increased interest in prion diseases. Among neurodegenerative disorders, however, prion diseases distinguish themselves for the broader phenotypic spectrum, the fastest disease progression and the existence of infectious forms that can be transmitted through the exposure to diseased tissues via ingestion, injection or transplantation. The main clinicopathological phenotypes of human prion disease include Creutzfeldt-Jakob disease, by far the most common, fatal insomnia, variably protease-sensitive prionopathy, and Gerstmann-Sträussler-Scheinker disease. However, clinicopathological manifestations extend even beyond those predicted by this classification. Because of their transmissibility, the phenotypic diversity of prion diseases can also be propagated into syngenic hosts as prion strains with distinct characteristics, such as incubation period, pattern of PrPSc distribution and regional severity of histopathological changes in the brain. Increasing evidence indicates that different PrPSc conformers, forming distinct ordered aggregates, encipher the phenotypic variants related to prion strains. In this review, we summarize the most recent advances concerning the histo-molecular pathology of human prion disease focusing on the phenotypic spectrum of the disease including co-pathologies, the characterization of prion strains by experimental transmission and their correlation with the physicochemical properties of PrPSc aggregates.
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Affiliation(s)
- Simone Baiardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marcello Rossi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Piero Parchi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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Abstract
Sporadic Creutzfeldt-Jakob disease (CJD), the most common human prion disease, is generally regarded as a spontaneous neurodegenerative illness, arising either from a spontaneous PRNP somatic mutation or a stochastic PrP structural change. Alternatively, the possibility of an infection from animals or other source remains to be completely ruled out. Sporadic CJD is clinically characterized by rapidly progressive dementia with ataxia, myoclonus, or other neurologic signs and, neuropathologically, by the presence of aggregates of abnormal prion protein, spongiform change, neuronal loss, and gliosis. Despite these common features the disease shows a wide phenotypic variability which was recognized since its early descriptions. In the late 1990s the identification of key molecular determinants of phenotypic expression and the availability of a large series of neuropathologically verified cases led to the characterization of definite clinicopathologic and molecular disease subtypes and to an internationally recognized disease classification. By showing that these disease subtypes correspond to specific agent strain-host genotype combinations, recent transmission studies have confirmed the biologic basis of this classification. The introduction of brain magnetic resonance imaging techniques such as fluid-attenuated inversion recovery and diffusion-weighted imaging sequences and cerebrospinal fluid biomarker assays for the detection of brain-derived proteins as well as real-time quaking-induced conversion assay, allowing the specific detection of prions in accessible biologic fluids and tissues, has significantly contributed to the improved accuracy of the clinical diagnosis of sporadic CJD in recent years.
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Affiliation(s)
- Inga Zerr
- Department of Neurology, University Hospital, Georg-August-University, Goettingen, Germany.
| | - Piero Parchi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna and IRCCS Institute of Neurological Sciences, Bologna, Italy
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Ntantos D, Aggelopoulos P, Kazis D, Dagklis IE, Bostantjopoulou S. Diagnostic challenge of non-specific visual symptoms: consideration of Heidenhain variant of Creutzfeldt-Jakob disease. Clin Exp Optom 2018; 101:311-313. [PMID: 28921636 DOI: 10.1111/cxo.12604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/01/2017] [Accepted: 06/16/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Dimitrios Ntantos
- 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Aggelopoulos
- 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Kazis
- 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis E Dagklis
- 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sevasti Bostantjopoulou
- 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abu Rumeileh S, Lattanzio F, Stanzani Maserati M, Rizzi R, Capellari S, Parchi P. Diagnostic Accuracy of a Combined Analysis of Cerebrospinal Fluid t-PrP, t-tau, p-tau, and Aβ42 in the Differential Diagnosis of Creutzfeldt-Jakob Disease from Alzheimer's Disease with Emphasis on Atypical Disease Variants. J Alzheimers Dis 2018; 55:1471-1480. [PMID: 27886009 PMCID: PMC5181677 DOI: 10.3233/jad-160740] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
According to recent studies, the determination of cerebrospinal fluid (CSF) total tau (t-tau)/phosphorylated tau (p-tau) ratio and total prion protein (t-PrP) levels significantly improves the accuracy of the diagnosis of Alzheimer’s disease (AD) in atypical cases with clinical or laboratory features mimicking Creutzfeldt-Jakob disease (CJD). However, this has neither been validated nor tested in series including atypical CJD variants. Furthermore, the added diagnostic value of amyloid-β (Aβ)42 remains unclear. To address these issues, we measured t-PrP, 14-3-3, t-tau, p-tau, and Aβ42 CSF levels in 45 typical and 44 atypical/rapidly progressive AD patients, 54 typical and 54 atypical CJD patients, and 33 controls. CJD patients showed significantly lower CSF t-PrP levels than controls and AD patients. Furthermore, atypical CJD was associated with lower t-PrP levels in comparison to typical CJD. T-tau, 14-3-3, or t-PrP alone yielded, respectively, 80.6, 63.0, and 73.0% sensitivity and 75.3, 92.1, and 75% specificity in distinguishing AD from CJD. On receiver operating characteristic (ROC) curve analyses of biomarker combinations, the (t-tau×Aβ42)/(p-tau×t-PrP) ratio achieved the best accuracy, with 98.1% sensitivity and 97.7% specificity overall, and 96.2% sensitivity and 95.5% specificity for the “atypical” disease groups. Our results show that the combined analysis of CSF t-PrP, t-tau, p-tau, and Aβ42 is clinically useful in the differential diagnosis between CJD and AD. Furthermore, the finding of reduced CSF t-PrP levels in CJD patients suggest that, likewise Aβ42 in AD, CSF t-PrP levels reflect the extent of PrPc conversion into abnormal PrP (PrPSc) and the burden of PrPSc deposition in CJD.
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Affiliation(s)
- Samir Abu Rumeileh
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Lattanzio
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Romana Rizzi
- Department of Neurology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Piero Parchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
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Lenk J, Engellandt K, Terai N, Bottesi A, Matthé E. Rapid progressive visual decline and visual field defects in two patients with the Heidenhain variant of Creutzfeld-Jakob disease. J Clin Neurosci 2018; 50:135-139. [PMID: 29429784 DOI: 10.1016/j.jocn.2018.01.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Heidenhain variant of Creutzfeldt-Jakob (HvCJD) is a rare disease, patients presenting with loss of visual acuity and a decline in visual fields. CASE PRESENTATION Two patients with rapid loss of visual acuity and declining visual fields presented with homonymic hemianopsia over several weeks. Cranial MRI showed neither stroke nor other morphological changes explaining the severe visual field defects. Neurological examination revealed no pathologies. However, lumbar puncture showed an increase in total protein in cerebrospinal fluid (CSF). Visual field testing revealed further deterioration during follow-up. Several weeks later, patients' behaviour changed markedly, exhibiting aggression, declining memory function and physical degeneration. The suspected diagnosis was the Heidenhain variant of Creutzfeld-Jakob disease (HvCJD). CSF analysis showed evidence of PrPSc and 14-3-3 protein. Both patients died within 8 weeks of the CJD diagnosis. CONCLUSIONS Loss of visual acuity and a decline in visual fields without corresponding MRI findings and marked changes in behaviour should lead to a diagnosis of HvCJD. Corresponding diagnostic tests should be performed for confirmation. The prognosis for survival is poor and should be immediately communicated to affected patients and their relatives.
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Affiliation(s)
- Janine Lenk
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
| | - Kay Engellandt
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Naim Terai
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Antonia Bottesi
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Egbert Matthé
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
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Townley RA, Dawson ET, Drubach DA. Heterozygous genotype at codon 129 correlates with prolonged disease course in Heidenhain variant sporadic CJD: case report. Neurocase 2018; 24:54-58. [PMID: 29436943 DOI: 10.1080/13554794.2018.1439067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rapid and fatal neurodegenerative disease defined by misfolded prion proteins accumulating in the brain. A minority of cases initially present with posterior cortical atrophy (PCA) phenotype, also known as Heidenhain variant or visual variant CJD. This case provides further evidence of sCJD presenting as PCA. The case also provides evidence for early DWI changes and cortical atrophy over 30 months before neurologic decline and subsequent death. The prolonged disease course correlates with prion protein codon 129 heterozygosity and coexistence of multiple prion strains.
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Affiliation(s)
- Ryan A Townley
- a Department of Neurology , Mayo Clinic , Rochester , MN , USA
| | - Elliot T Dawson
- a Department of Neurology , Mayo Clinic , Rochester , MN , USA
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Fragoso DC, Gonçalves Filho ALDM, Pacheco FT, Barros BR, Aguiar Littig I, Nunes RH, Maia Júnior ACM, da Rocha AJ. Imaging of Creutzfeldt-Jakob Disease: Imaging Patterns and Their Differential Diagnosis. Radiographics 2017; 37:234-257. [PMID: 28076012 DOI: 10.1148/rg.2017160075] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) remains a challenge because of the large variability of the clinical scenario, especially in its early stages, which may mimic several reversible or treatable disorders. The molecular basis of prion disease, as well as its brain propagation and the pathogenesis of the illness, have become better understood in recent decades. Several reports have listed recognizable clinical features and paraclinical tests to supplement the replicable diagnostic criteria in vivo. Nevertheless, we lack specific data about the differential diagnosis of CJD at imaging, mainly regarding those disorders evolving with similar clinical features (mimicking disorders). This review provides an update on the neuroimaging patterns of sCJD, emphasizing the relevance of magnetic resonance (MR) imaging, summarizing the clinical scenario and molecular basis of the disease, and highlighting clinical, genetic, and imaging correlations in different subtypes of prion diseases. A long list of differential diagnoses produces a comprehensive pictorial review, with the aim of enabling radiologists to identify typical and atypical patterns of sCJD. This review reinforces distinguishable imaging findings and confirms diffusion-weighted imaging (DWI) features as pivotal in the diagnostic workup of sCJD, as these findings enable radiologists to reliably recognize this rare but invariably lethal disease. A probable diagnosis is justified when expected MR imaging patterns are demonstrated and CJD-mimicking disorders are confidently ruled out. ©RSNA, 2017.
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Affiliation(s)
- Diego Cardoso Fragoso
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Augusto Lio da Mota Gonçalves Filho
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Felipe Torres Pacheco
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Bernardo Rodi Barros
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Ingrid Aguiar Littig
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Renato Hoffmann Nunes
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Antônio Carlos Martins Maia Júnior
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Antonio J da Rocha
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
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Ehler E, Pipka M, Meleková A, Mandysová P, Johanidesová S, Matěj R, Rusina R. The Heidenhain variant of Creutzfeldt-Jakob disease and concomitant tau pathology: A case report. Neurol Neurochir Pol 2017; 51:197-200. [PMID: 28236445 DOI: 10.1016/j.pjnns.2017.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/19/2017] [Indexed: 11/19/2022]
Abstract
The Heidenhain form of Creutzfeldt-Jakob disease (CJD) is a rare CJD variant with predominantly visual symptoms in the early stages. Clinical manifestations of metamorphopsia, hemianopia and Balint's syndrome correlate with the involvement of the posterior cortical regions. A 71-year old healthy and very active man was admitted because of impaired visual acuity, hemianopia, and gait disturbance progressing over one week. MRI found typical cortical hyperintensities in the occipital regions while rhythm slowing and sharp waves were seen in the occipital regions on EEG. Protein 14-3-3 was detected in the cerebrospinal fluid. Postmortem neuropathology revealed typical histopathological changes consistent with CJD. Moreover, we found deposits of phosphorylated tau protein in the limbic regions that met the criteria for primary age-related tauopathy (PART); representing an additional and interesting finding in our case.
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Affiliation(s)
- Edvard Ehler
- Department of Neurology, Regional Hospital Pardubice, Czech Republic
| | - Michael Pipka
- Department of Neurology, Regional Hospital Pardubice, Czech Republic
| | - Alena Meleková
- Department of Neurology, Regional Hospital Pardubice, Czech Republic
| | - Petra Mandysová
- Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic; Department of Neurology, Regional Hospital Pardubice, Czech Republic
| | - Silvie Johanidesová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and the General University Hospital, Prague, Czech Republic
| | - Radoslav Matěj
- Department of Pathology and Molecular Medicine, Thomayer Hospital, Prague, Czech Republic; Department of Pathology, First Faculty of Medicine, Charles University in Prague and the General University Hospital, Prague, Czech Republic
| | - Robert Rusina
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and the General University Hospital, Prague, Czech Republic; Department of Neurology, Thomayer Hospital, Prague, Czech Republic
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Dirzius E, Balnyte R, Steibliene V, Gleizniene R, Gudinaviciene I, Radziunas A, Petrikonis K. Sporadic Creutzfeldt-Jakob disease with unusual initial presentation as posterior reversible encephalopathy syndrome: a case report. BMC Neurol 2016; 16:234. [PMID: 27876002 PMCID: PMC5120446 DOI: 10.1186/s12883-016-0751-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 11/10/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Creutzfeldt - Jakob disease (CJD) is a rapidly progressive and fatal neurodegenerative prion disease. MRI findings are included in diagnostic criteria for probable CJD, giving a sensitivity and specificity more than 90%, but the atypical radiological presentations in the early stage of the disease could cause the diagnostic difficulties. CJD can be definitively diagnosed by histopathological confirmation, brain biopsy or at autopsy. CASE PRESENTATION We present a case of 53-year-old woman with a history of a rapidly progressive dementia with symptoms of visual impairment, increased extrapyramidal type muscle tonus, stereotypical movements and ataxic gait resulting in the patient's death after13 months. The clinical symptoms deteriorated progressively to myoclonus and akinetic mutism already on the 14th week. The series of diagnostic examinations were done to exclude the possible causes of dementia. Initial MRI evaluation as posterior reversible encephalopathy syndrome (PRES) on the 9th week after the onset of symptoms created us a diagnostic conundrum. Subsequent MRI findings of symmetrical lesions in the basal ganglia (nucleus caudatus, putamen) on the 13th week and EEG with periodic sharp wave complexes (PSWC) in frontal regions on the 18th week allowed us to diagnose the probable sCJD. The histopathological findings after brain biopsy on the 14th week demonstrated the presence of the abnormal prion protein deposits in the grey matter by immunohistochemistry with ICSM35, KG9 and 12 F10 antibodies and confirmed the diagnosis of sCJD. CONCLUSIONS In this article we focus our attention on a rare association between radiological PRES syndrome and early clinical stage of sCJD. Although concurrent manifestation of these conditions can be accidental, but the immunogenic or neuropeptide mechanisms could explain such radiological MRI findings. A thorough knowledge of differential diagnostic of PRES may be especially useful in earlier diagnosis of sCJD.
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Affiliation(s)
- Edgaras Dirzius
- Department of Psychiatry, Lithuanian University of Health Sciences, Mickeviciaus str. 9, Kaunas, LT-44307 Lithuania
| | - Renata Balnyte
- Department of Neurology Lithuanian University of Health Sciences, Mickeviciaus str. 9, Kaunas, LT-44307 Lithuania
| | - Vesta Steibliene
- Department of Psychiatry, Lithuanian University of Health Sciences, Mickeviciaus str. 9, Kaunas, LT-44307 Lithuania
| | - Rymante Gleizniene
- Department of Radiology Lithuanian University of Health Sciences, Mickeviciaus str. 9, Kaunas, LT-44307 Lithuania
| | - Inga Gudinaviciene
- Department of Pathology Lithuanian University of Health Sciences, Mickeviciaus str. 9, Kaunas, LT-44307 Lithuania
| | - Andrius Radziunas
- Department of Neurosurgery Lithuanian University of Health Sciences, Mickeviciaus str. 9, Kaunas, LT-44307 Lithuania
| | - Kestutis Petrikonis
- Department of Neurology Lithuanian University of Health Sciences, Mickeviciaus str. 9, Kaunas, LT-44307 Lithuania
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Vita MG, Tiple D, Bizzarro A, Ladogana A, Colaizzo E, Capellari S, Rossi M, Parchi P, Masullo C, Pocchiari M. Patient with rapidly evolving neurological disease with neuropathological lesions of Creutzfeldt-Jakob disease, Lewy body dementia, chronic subcortical vascular encephalopathy and meningothelial meningioma. Neuropathology 2016; 37:110-115. [PMID: 27634418 DOI: 10.1111/neup.12343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/28/2022]
Abstract
We report a case of rapidly evolving neurological disease in a patient with neuropathological lesions of Creutzfeldt-Jakob disease (CJD), Lewy body dementia (LBD), chronic subcortical vascular encephalopathy and meningothelial meningioma. The coexistence of severe multiple pathologies in a single patient strengthens the need to perform accurate clinical differential diagnoses in rapidly progressive dementias.
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Affiliation(s)
| | - Dorina Tiple
- Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Rome, Italy
| | | | - Anna Ladogana
- Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Rome, Italy
| | - Elisa Colaizzo
- Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Rome, Italy
| | - Sabina Capellari
- Dipartimento di Scienze Biomediche e Neuromotorie (DiBiNeM), Università di Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Marcello Rossi
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Piero Parchi
- Dipartimento di Scienze Biomediche e Neuromotorie (DiBiNeM), Università di Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Carlo Masullo
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Pocchiari
- Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Rome, Italy
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