Diagnostic challenge of rapidly progressing sporadic Creutzfeldt-Jakob disease

BMJ Case Rep. 2019 Sep 24;12(9):e230535. doi: 10.1136/bcr-2019-230535.

Abstract

Antemortem assessment of sporadic Creutzfeldt-Jakob disease (sCJD) can be significantly hampered due to its rarity, low index of clinical suspicion and its non-specific clinical features. We present an atypical case of definitive sCJD. The patient died within 5 weeks of the disease onset. This unusually short duration of disease presented a significant diagnostic dilemma. The patient presented with 2-week history of sudden-onset cognitive decline, memory loss, aphasia and ataxia. MRI Diffusion-weighted sequences revealed cortical ribboning sign without cerebral atrophy. Protein 14-3-3 from cerebrospinal fluid (CSF) was detected, and postmortem brain autopsy confirmed the diagnosis of sCJD. This case underscores the importance of considering CJD as a potential diagnosis for rapidly progressive dementia. Serology tests, EEG, MRI and CSF study are invaluable diagnostic tools when assessing for sCJD. Appropriate use of those diagnostic tests, along with a detailed clinical examination, can successfully and promptly exclude other differential diagnoses and confirm sCJD.

Keywords: Infection (neurology); Memory Disorders; Neuroimaging; Neurology.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Creutzfeldt-Jakob Syndrome / diagnostic imaging*
  • Dementia / diagnostic imaging*
  • Diagnosis, Differential
  • Diffusion Magnetic Resonance Imaging
  • Fatal Outcome
  • Humans
  • Male

Supplementary concepts

  • Creutzfeldt-Jakob Disease, Sporadic