A 66‐Year‐Old Woman with a Rapidly Progressing Dementia and Basal Ganglia Involvement

A 66‐year‐old woman presented with a rapidly progressive dementia initially characterized by an auditory agnosia. She experienced a rapid progression of her aphasia and developed ataxia and myoclonus. An initial neurological evaluation suggested a left parieto‐temporal lesion, however, neuroimaging did not reveal any. An MRI of her brain demonstrated highly focal T2 hyperintensities in her basal ganglia. The patient was diagnosed with Creutzfeldt‐Jacob Disease (CJD) on the basis of the presence of two proteins in the CSF that are highly sensitive and specific for CJD. Pathological examination confirmed the diagnosis. The differential diagnosis and utility of MRI in patients with CJD is discussed.

[1]  C. Gibbs,et al.  The 14-3-3 brain protein in cerebrospinal fluid as a marker for transmissible spongiform encephalopathies. , 1996, The New England journal of medicine.

[2]  I. Zerr,et al.  MR imaging of Creutzfeldt-Jakob disease. , 1996, Radiology.

[3]  P. Brown,et al.  Intracerebral distribution of infectious amyloid protein in spongiform encephalopathy , 1995, Annals of neurology.

[4]  W. Schlote,et al.  Tissue Handling in Suspected Creutzfeldt‐Jakob Disease (CJD) and Other Human Spongiform Encephalopathies (Prion Diseases) , 1995, Brain pathology.

[5]  H. Kretzschmar,et al.  Cerebrospinal fluid concentration of neuron-specific enolase in diagnosis of Creutzfeldt-Jakob disease , 1995, The Lancet.

[6]  S. Fredstrom,et al.  Extrapyramidal symptoms in a BMT recipient with hyperintense basal ganglia and elevated manganese. , 1995, Bone marrow transplantation.

[7]  J. Aharon-Peretz,et al.  SPECT diagnosis of Creutzfeld-Jacob disease. , 1995, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[8]  M. Kupersmith,et al.  Homonymous field defect as the first manifestation of Creutzfeldt-Jakob disease. , 1995, American journal of ophthalmology.

[9]  M. McInnis,et al.  Clinical features of early onset, familial Alzheimer's disease linked to chromosome 14. , 1995, American journal of medical genetics.

[10]  T. Strine,et al.  Epidemiology of Creutzfeldt-Jakob disease in the United States, 1979-1990: analysis of national mortality data. , 1995, Neuroepidemiology.

[11]  K. Ikeda,et al.  Magnetic resonance imaging and neuropathological findings in two patients with Creutzfeldt-Jakob disease , 1994, Journal of the Neurological Sciences.

[12]  A. Kirk,et al.  Unilateral Creutzfeldt-Jakob Disease Presenting as Rapidly Progressive Aphasia , 1994, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[13]  P. Brown,et al.  Human spongiform encephalopathy: The national institutes of health series of 300 cases of experimentally transmitted disease , 1994, Annals of neurology.

[14]  H. Matsuda,et al.  Utility of 123I-IMP SPECT brain scans for the early detection of site-specific abnormalities in Creutzfeldt-Jakob disease (Heidenhain type): a case study. , 1994, Neuropsychobiology.

[15]  J. Provenzale,et al.  MR diagnosis of Creutzfeldt-Jakob disease: significance of high signal intensity of the basal ganglia. , 1994, AJR. American journal of roentgenology.

[16]  A. Lang,et al.  Case 1, 1994: Rapidly progressive aphasia, apraxia, dementia, myoclonus, and parkinsonism , 1994, Movement disorders : official journal of the Movement Disorder Society.

[17]  S. DeArmond,et al.  Alzheimer's disease and Creutzfeldt‐Jakob disease: overlap of pathogenic mechanisms , 1993, Current opinion in neurology.

[18]  M. Onofrj,et al.  MRI alterations as an early finding in Creutzfeld-Jakob disease. , 1993, European journal of radiology.

[19]  J. Bell,et al.  Neuropathology of spongiform encephalopathies in humans. , 1993, British medical bulletin.

[20]  P. Goldman-Rakic,et al.  Proton magnetic resonance spectroscopy in Creutzfeldt‐Jakob disease , 1993, Neurology.

[21]  D. Gajdusek Genetic control of nucleation and polymerization of host precursors to infectious amyloids in the transmissible amyloidoses of brain. , 1993, British medical bulletin.

[22]  A. Luxen,et al.  Positron emission tomography and histopathology in Creutzfeldt‐Jakob disease , 1993, Neurology.

[23]  H. Kretzschmar Neuropathology of human prion diseases (spongiform encephalopathies). , 1993, Developments in biological standardization.

[24]  K. Kato,et al.  High levels of nervous system-specific proteins in cerebrospinal fluid in patients with early stage Creutzfeldt-Jakob disease. , 1992, Clinica chimica acta; international journal of clinical chemistry.

[25]  Takeo Kato,et al.  Marked increase in cerebrospinal fluid ubiquitin in Creutzfeldt-Jakob disease , 1992, Neuroscience Letters.

[26]  V. Pietrini Creutzfeldt-Jakob disease presenting as Wernicke-Korsakoff syndrome , 1992, Journal of the Neurological Sciences.

[27]  T. Kuwabara,et al.  Serial computed tomographic and electroencephalographic studies in Creutzfeldt‐Jakob disease , 1992, Acta neurologica Scandinavica.

[28]  H. Y. Chen,et al.  Fatal familial insomnia, a prion disease with a mutation at codon 178 of the prion protein gene. , 1992, The New England journal of medicine.

[29]  A. Buescu,et al.  Abnormal proteins in the cerebrospinal fluid of a patient with Creutzfeldt-Jakob disease following administration of human pituitary growth hormone. , 1992, Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas.

[30]  P. Castaigne,et al.  The epidemiology of Creutzfeldt‐Jakob disease , 1987, Neurology.

[31]  W. Hauser,et al.  Seizures and myoclonus in patients with Alzheimer's disease , 1986, Neurology.

[32]  C. Merril,et al.  Abnormal proteins in the cerebrospinal fluid of patients with Creutzfeldt-Jakob disease. , 1986, The New England journal of medicine.