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Sahyouni M, Casey B, Carpenter Z, Estrella F, Okafor C. Euphoric Presentation in Creutzfeldt-Jakob Disease and Its Diagnostic Implications: A Case Report. Cureus 2024; 16:e57419. [PMID: 38694643 PMCID: PMC11062774 DOI: 10.7759/cureus.57419] [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: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
Creutzfeldt-Jakob disease (CJD) constitutes an aggressively advancing, terminal neurodegenerative condition classified within the spectrum of transmissible spongiform encephalopathies. The difficulty in establishing a diagnosis before death arises from the condition's rarity and the resulting limited level of suspicion attributed to it. The polymorphic nature of CJD symptoms contributes to the challenge of early diagnostic recognition. Emotional and behavioral changes have been well documented, but the initial presentation of euphoria has not been documented. Here, we present the case of a female patient who was experiencing an unusual state of euphoria followed by intermittently altered mental status. She was ultimately diagnosed with sporadic CJD, discharged home on hospice, and died within six months of discharge.
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Affiliation(s)
- Mark Sahyouni
- Internal Medicine, Campbell University School of Osteopathic Medicine, Buies Creek, USA
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Bradley Casey
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Zachary Carpenter
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Frank Estrella
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Chika Okafor
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
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2
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Zerr I, Ladogana A, Mead S, Hermann P, Forloni G, Appleby BS. Creutzfeldt-Jakob disease and other prion diseases. Nat Rev Dis Primers 2024; 10:14. [PMID: 38424082 DOI: 10.1038/s41572-024-00497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
Prion diseases share common clinical and pathological characteristics such as spongiform neuronal degeneration and deposition of an abnormal form of a host-derived protein, termed prion protein. The characteristic features of prion diseases are long incubation times, short clinical courses, extreme resistance of the transmissible agent to degradation and lack of nucleic acid involvement. Sporadic and genetic forms of prion diseases occur worldwide, of which genetic forms are associated with mutations in PRNP. Human to human transmission of these diseases has occurred due to iatrogenic exposure, and zoonotic forms of prion diseases are linked to bovine disease. Significant progress has been made in the diagnosis of these disorders. Clinical tools for diagnosis comprise brain imaging and cerebrospinal fluid tests. Aggregation assays for detection of the abnormally folded prion protein have a clear potential to diagnose the disease in peripherally accessible biofluids. After decades of therapeutic nihilism, new treatment strategies and clinical trials are on the horizon. Although prion diseases are relatively rare disorders, understanding their pathogenesis and mechanisms of prion protein misfolding has significantly enhanced the field in research of neurodegenerative diseases.
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Affiliation(s)
- Inga Zerr
- National Reference Center for CJD Surveillance, Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany.
| | - Anna Ladogana
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Simon Mead
- MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK
| | - Peter Hermann
- National Reference Center for CJD Surveillance, Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany
| | - Gianluigi Forloni
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Brian S Appleby
- Departments of Neurology, Psychiatry and Pathology, Case Western Reserve University, Cleveland, OH, USA
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3
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Satyadev N, Tipton PW, Martens Y, Dunham SR, Geschwind MD, Morris JC, Brier MR, Graff-Radford NR, Day GS. Improving Early Recognition of Treatment-Responsive Causes of Rapidly Progressive Dementia: The STAM 3 P Score. Ann Neurol 2024; 95:237-248. [PMID: 37782554 PMCID: PMC10841446 DOI: 10.1002/ana.26812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To improve the timely recognition of patients with treatment-responsive causes of rapidly progressive dementia (RPD). METHODS A total of 226 adult patients with suspected RPD were enrolled in a prospective observational study and followed for up to 2 years. Diseases associated with RPD were characterized as potentially treatment-responsive or non-responsive, referencing clinical literature. Disease progression was measured using Clinical Dementia Rating® Sum-of-Box scores. Clinical and paraclinical features associated with treatment responsiveness were assessed using multivariable logistic regression. Findings informed the development of a clinical criterion optimized to recognize patients with potentially treatment-responsive causes of RPD early in the diagnostic evaluation. RESULTS A total of 155 patients met defined RPD criteria, of whom 86 patients (55.5%) had potentially treatment-responsive causes. The median (range) age-at-symptom onset in patients with RPD was 68.9 years (range 22.0-90.7 years), with a similar number of men and women. Seizures, tumor (disease-associated), magnetic resonance imaging suggestive of autoimmune encephalitis, mania, movement abnormalities, and pleocytosis (≥10 cells/mm3 ) in cerebrospinal fluid at presentation were independently associated with treatment-responsive causes of RPD after controlling for age and sex. Those features at presentation, as well as age-at-symptom onset <50 years (ie, STAM3 P), captured 82 of 86 (95.3%) cases of treatment-responsive RPD. The presence of ≥3 STAM3 P features had a positive predictive value of 100%. INTERPRETATION Selected features at presentation reliably identified patients with potentially treatment-responsive causes of RPD. Adaptation of the STAM3 P screening score in clinical practice may minimize diagnostic delays and missed opportunities for treatment in patients with suspected RPD. ANN NEUROL 2024;95:237-248.
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Affiliation(s)
- Nihal Satyadev
- Mayo Clinic Florida, Department of Neurology; Jacksonville, FL
- Georgia Institute of Technology, Atlanta, GA
| | - Philip W Tipton
- Mayo Clinic Florida, Department of Neurology; Jacksonville, FL
| | - Yuka Martens
- Mayo Clinic Florida, Department of Neuroscience; Jacksonville, FL
| | - S Richard Dunham
- Washington University School of Medicine, Department of Neurology, Saint Louis, MO
| | - Michael D Geschwind
- University of California San Francisco, Department of Neurology, Memory and Aging Center, San Francisco, CA
| | - John C Morris
- Washington University School of Medicine, Department of Neurology, Saint Louis, MO
| | - Matthew R Brier
- Washington University School of Medicine, Department of Neurology, Saint Louis, MO
| | | | - Gregory S Day
- Mayo Clinic Florida, Department of Neurology; Jacksonville, FL
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4
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Yaqub A, Ikram MK, Blankevoort J, Ikram MA. Diagnostic challenge of Creutzfeldt-Jakob disease in a patient with multimorbidity: a case-report. BMC Neurol 2023; 23:346. [PMID: 37784069 PMCID: PMC10544493 DOI: 10.1186/s12883-023-03401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Creutzfeldt-Jakob disease (CJD) is a rapidly progressive and ultimately fatal neurodegenerative condition caused by prions. The clinical symptoms of CJD vary with its subtype, and may include dementia, visual hallucinations, myoclonus, ataxia, (extra)pyramidal signs and akinetic mutism. In the early course of disease however, several clinical symptoms of CJD may mimic those of co-existing morbidities. CASE PRESENTATION We report a male in his 60s with a history of situs inversus totalis and Churg Strauss syndrome, who presented with speech fluency disturbances, neuropsychiatric symptoms and allodynia, a few months after becoming a widower. Initially presumed a bereavement disorder along with a flare-up of Churg Strauss, his symptoms gradually worsened with apraxia, myoclonic jerks and eventually, akinetic mutism. MRI revealed hyperintensities at the caudate nucleus and thalami, while the cerebrospinal fluid was positive for the 14-3-3 protein and the real-time quick test, making the diagnosis of CJD highly probable. This case illustrates the complexities that may arise in diagnosing CJD when pre-existing multimorbidity may cloud the clinical presentation. We also discuss the potential mechanisms underlying the co-occurrence of three rare conditions (situs inversus totalis, Churg Strauss syndrome, CJD) in one patient, taking into consideration the possibility of coincidence as well as common underlying factors. CONCLUSIONS The diagnosis of CJD may be easily missed when its clinical symptoms are obscured by those of pre-existing (rare) multimorbidity. This case highlights that when the multimorbidity has neurological manifestations, an extensive evaluation remains crucial to establish the diagnosis, minimize the risk of prion-transmission and provide appropriate guidance to patients and their caregivers.
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Affiliation(s)
- Amber Yaqub
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mohammad Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Mohammad Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
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5
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Jabarkhil AA, Rasib AR, Asady A, Farzam F. Misdiagnosis of rarest subtype of sporadic Creutzfeldt Jakob Disease: a case report. BMC Neurol 2023; 23:274. [PMID: 37464286 DOI: 10.1186/s12883-023-03318-z] [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: 11/24/2022] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Creutzfeldt-Jakob disease (CJD), is a deadly degenerative condition of the central nervous system marked by rapidly progressive dementia. Magnetic resonance imaging (MRI) abnormalities in the cerebral cortex, basal ganglia, thalamus, and cerebellum could indicate severe acute diseases caused by a variety of factors. Although their MRI patterns may resemble those of CJD, clinical history, additional MRI findings, and laboratory testing are all necessary to provide a reliable difference. Here, we report a misdiagnosed case of probable VV1 subtype of sporadic CJD (sCJD) in which follow-up MRI supported the diagnosis. CASE PRESENTATION A 41-year-old male patient attended the Neuropsychiatry Department with rapidly progressive dementia, akinetic mutism, and difficulty walking and speaking. His problem began with forgetfulness, disorganized behavior, and disorganized speech 7 months earlier which progressed rapidly and was accompanied by aphasia, apraxia, agnosia, and akinetic mutism in the last 2 months. On neurologic examination, hypertonia, hyperreflexia, frontal ataxia, bradykinesia, gait apraxia, and aphasia were noted. Based on clinical features and rapid symptoms progression the likely diagnosis of CJD was suspected. MRI and electroencephalography (EEG) were advised. MRI revealed features of diffuse cortical injury of both cerebral hemispheres also involving bilateral corpus striatum with evidence of cerebral volume loss. EEG showed lateralized periodic theta slow waves on the right side. According to the CDC's diagnostic criteria for CJD, the diagnosis of probable sCJD was established. Supportive care and symptomatic treatment are provided for the patient. After a 1-month follow up the patient's condition deteriorated significantly. The time-lapse from the first reported symptom to death was about 13 months. CONCLUSION The need of addressing CJD in patients presenting with rapidly progressive dementia is highlighted in this case report. In the early stages of the disease, interpretation of MRI results might cause diagnostic difficulties; therefore, follow-up MRI is critical in obtaining the correct diagnosis.
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Affiliation(s)
- Aemal Aziz Jabarkhil
- Department of Neuropsychiatry, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan
| | - Aziz Rahman Rasib
- Department of Neuropsychiatry, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan.
| | - Abdullah Asady
- Department of Microbiology, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan
| | - Farhad Farzam
- Department of Medical Imaging and Radiation Sciences, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan
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6
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Sideman AB, Gilissen J, Harrison KL, Garrett SB, Terranova MJ, Ritchie CS, Geschwind MD. Caregiver Experiences Navigating the Diagnostic Journey in a Rapidly Progressing Dementia. J Geriatr Psychiatry Neurol 2022:8919887221135552. [PMID: 36412170 DOI: 10.1177/08919887221135552] [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: 11/23/2022]
Abstract
INTRODUCTION People with suspected Alzheimer's disease and related dementias (ADRD) and their families experience a burdensome process while seeking a diagnosis. These challenges are problematic in the most common dementia syndromes, but they can be even more distressing in rarer, atypical syndromes such as rapidly progressive dementias (RPDs), which can be fatal within months from onset. This study is an examination of the diagnostic journey experience from the perspective of caregivers of people who died from the prototypic RPD, sporadic Creutzfeldt-Jakob Disease (sCJD). METHODS eIn this mixed-methods study, qualitative data were drawn from interviews with former caregivers of 12 people who died from sCJD. Chart review data were drawn from research and clinical chart data about the person with sCJD. Data were analyzed by a multidisciplinary research team using qualitative and descriptive statistical analysis. RESULTS We identified 4 overarching themes that characterized the experience of the diagnostic journey in sCJD: clinician knowledge, clinician communication, experiences of uncertainty, and the caregiver as advocate. We also identified 4 phases along the diagnostic journey: recognition, the diagnostic workup, diagnosis, and post-diagnosis. Sub-themes within each phase include struggles to recognize what is wrong, complex processes of testing and referrals, delay and disclosure of diagnosis, and access to resources post-diagnosis. CONCLUSIONS Findings suggest that more work is needed to improve clinician diagnostic knowledge and communication practices. Furthermore, caregivers need better support during the diagnostic journey. What we learn from studying sCJD and other RPDs is likely applicable to other more common dementias.
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Affiliation(s)
- Alissa Bernstein Sideman
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, CA, USA.,Department of Humanities and Social Sciences, 8785University of California San Francisco, San Francisco, CA, USA.,Department of Neurology, 8785University of California San Francisco, San Francisco, CA, USA
| | - Joni Gilissen
- Global Brain Health Institute, University of California, San Francisco, CA, USA.,Department Family Medicine & Chronic Care, 70493Vrije Universiteit Brussel(VUB), Belgium
| | - Krista L Harrison
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, CA, USA.,Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Sarah B Garrett
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Michael J Terranova
- Department of Neurology, 8785University of California San Francisco, San Francisco, CA, USA
| | - Christine S Ritchie
- Global Brain Health Institute, University of California, San Francisco, CA, USA.,The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Michael D Geschwind
- Department of Neurology, 8785University of California San Francisco, San Francisco, CA, USA
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7
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Raut A, Thapa A, Shrestha A, Saud K, Rajbhandari R, Katwal S. Creutzfeldt–Jakob
disease: A case report and differential diagnoses. Clin Case Rep 2022; 10:e6239. [PMID: 35957791 PMCID: PMC9364331 DOI: 10.1002/ccr3.6239] [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: 05/02/2022] [Revised: 07/05/2022] [Accepted: 07/23/2022] [Indexed: 11/24/2022] Open
Abstract
Although sporadic Creutzfeldt–Jakob disease is a rare neurodegenerative disease and often difficult to diagnose at the earliest onset, meticulous clinical examination, electroencephalography, and neuroimaging findings will help in diagnosis.
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Affiliation(s)
- Akash Raut
- Maharajgunj Medical Campus Institute of Medicine Kathmandu Nepal
| | - Anjila Thapa
- Maharajgunj Medical Campus Institute of Medicine Kathmandu Nepal
| | - Ashish Shrestha
- Department of Neurology Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Kamal Saud
- Department of Neurology Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Reema Rajbhandari
- Department of Neurology Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Shailendra Katwal
- Department of Radiology Tribhuvan University Teaching Hospital Kathmandu Nepal
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8
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Degenerative dementias: a question of syndrome or disease? NEUROLOGÍA (ENGLISH EDITION) 2022; 37:480-491. [DOI: 10.1016/j.nrleng.2019.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/07/2019] [Indexed: 11/20/2022] Open
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9
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Robles Bayón A. Degenerative dementias: A question of syndrome or disease? Neurologia 2022; 37:480-491. [PMID: 31331676 DOI: 10.1016/j.nrl.2019.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Neurologists refer to numerous "syndromes,‿ consisting of specific combinations of clinical manifestations, following a specific progression pattern, and with the support of blood analysis (without genomic-proteomic parameters) and neuroimaging findings (MRI, CT, perfusion SPECT, or 18F-FDG-PET scans). Neurodegenerative "diseases,‿ on the other hand, are defined by specific combinations of clinical signs and histopathological findings; these must be confirmed by a clinical examination and a histology study or evidence of markers of a specific disorder for the diagnosis to be made. However, we currently know that most genetic and histopathological alterations can result in diverse syndromes. The genetic or histopathological aetiology of each syndrome is also heterogeneous, and we may encounter situations with pathophysiological alterations characterising more than one neurodegenerative disease. Sometimes, specific biomarkers are detected in the preclinical stage. DEVELOPMENT We performed a literature review to identify patients whose histopathological or genetic disorder was discordant with that expected for the clinical syndrome observed, as well as patients presenting multiple neurodegenerative diseases, confirming the heterogeneity and overlap between syndromes and diseases. We also observed that the treatments currently prescribed to patients with neurodegenerative diseases are symptomatic. CONCLUSIONS Our findings show that the search for disease biomarkers should be restricted to research centres, given the lack of disease-modifying drugs or treatments improving survival. Moreover, syndromes and specific molecular or histopathological alterations should be managed independently of one another, and new "diseases‿ should be defined and adapted to current knowledge and practice.
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Affiliation(s)
- A Robles Bayón
- Unidad de Neurología Cognitiva, Hospital HM Rosaleda, Santiago de Compostela, La Coruña, España.
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10
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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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11
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Foster H, Barker A, Nirodi P, Ahmed Y. Diagnostic overshadowing in sporadic
Creutzfeldt‐Jakob
disease? PROGRESS IN NEUROLOGY AND PSYCHIATRY 2022. [DOI: 10.1002/pnp.743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Harry Foster
- Dr Foster and Dr Barker are Core Psychiatry Trainees at Tees Esk and Wear Valleys Foundation Trust (TEWV)
| | - Amy Barker
- Dr Foster and Dr Barker are Core Psychiatry Trainees at Tees Esk and Wear Valleys Foundation Trust (TEWV)
| | - Pratibha Nirodi
- Dr Nirodi is Consultant Liaison and Old Age Psychiatrist at Harrogate District Hospital, Foundation Training Programme Director at Health Education England (HEE) and Undergraduate Tutor at Tees Esk and Wear Valleys NHS Foundation Trust (TEWV)
| | - Yasmin Ahmed
- Dr Ahmed is Consultant Liaison Psychiatrist at Harrogate District Hospital
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12
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Harrison KL, Garrett SB, Gilissen J, Terranova MJ, Bernstein Sideman A, Ritchie CS, Geschwind MD. Developing neuropalliative care for sporadic Creutzfeldt-Jakob Disease. Prion 2022; 16:23-39. [PMID: 35239456 PMCID: PMC8896185 DOI: 10.1080/19336896.2022.2043077] [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: 11/24/2022] Open
Abstract
We aimed to identify targets for neuropalliative care interventions in sporadic Creutzfeldt-Jakob disease by examining characteristics of patients and sources of distress and support among former caregivers. We identified caregivers of decedents with sporadic Creutzfeldt-Jakob disease from the University of California San Francisco Rapidly Progressive Dementia research database. We purposively recruited 12 caregivers for in-depth interviews and extracted associated patient data. We analysed interviews using the constant comparison method and chart data using descriptive statistics. Patients had a median age of 70 (range: 60–86) years and disease duration of 14.5 months (range 4–41 months). Caregivers were interviewed a median of 22 (range 11–39) months after patient death and had a median age of 59 (range 45–73) years. Three major sources of distress included (1) the unique nature of sporadic Creutzfeldt-Jakob disease; (2) clinical care issues such as difficult diagnostic process, lack of expertise in sporadic Creutzfeldt-Jakob disease, gaps in clinical systems, and difficulties with end-of-life care; and (3) caregiving issues, including escalating responsibilities, intensifying stress, declining caregiver well-being, and care needs surpassing resources. Two sources of support were (1) clinical care, including guidance from providers about what to expect and supportive relationships; and (2) caregiving supports, including connection to persons with experience managing Creutzfeldt-Jakob disease, instrumental support, and social/emotional support. The challenges and supports described by caregivers align with neuropalliative approaches and can be used to develop interventions to address needs of persons with sporadic Creutzfeldt-Jakob disease and their caregivers.
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Affiliation(s)
- Krista L Harrison
- Division of Geriatrics, University of California, San Francisco, USA.,Philip R. University of California, San Francisco, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA
| | | | - Joni Gilissen
- Global Brain Health Institute, University of California, San Francisco, California, USA.,End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (Vub), Belgium
| | - Michael J Terranova
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Philip R. University of California, San Francisco, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA.,Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, California, USA
| | - Christine S Ritchie
- Division of Geriatrics, University of California, San Francisco, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA.,The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, USA
| | - Michael D Geschwind
- Global Brain Health Institute, University of California, San Francisco, California, USA.,Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
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13
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Tsou A, Chen PJ, Tsai KW, Hu WC, Lu KC. THαβ Immunological Pathway as Protective Immune Response against Prion Diseases: An Insight for Prion Infection Therapy. Viruses 2022; 14:v14020408. [PMID: 35216001 PMCID: PMC8877887 DOI: 10.3390/v14020408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/29/2022] [Accepted: 02/15/2022] [Indexed: 01/08/2023] Open
Abstract
Prion diseases, including Creutzfeldt–Jakob disease, are mediated by transmissible proteinaceous pathogens. Pathological changes indicative of neuro-degeneration have been observed in the brains of affected patients. Simultaneously, microglial activation, along with the upregulation of pro-inflammatory cytokines, including IL-1 or TNF-α, have also been observed in brain tissue of these patients. Consequently, pro-inflammatory cytokines are thought to be involved in the pathogenesis of these diseases. Accelerated prion infections have been seen in interleukin-10 knockout mice, and type 1 interferons have been found to be protective against these diseases. Since interleukin-10 and type 1 interferons are key mediators of the antiviral THαβ immunological pathway, protective host immunity against prion diseases may be regulated via THαβ immunity. Currently no effective treatment strategies exist for prion disease; however, drugs that target the regulation of IL-10, IFN-alpha, or IFN-β, and consequently modulate the THαβ immunological pathway, may prove to be effective therapeutic options.
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Affiliation(s)
- Adam Tsou
- Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan;
| | - Po-Jui Chen
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan City 325, Taiwan;
| | - Kuo-Wang Tsai
- Department of Medical Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (K.-W.T.); (K.-C.L.)
| | - Wan-Chung Hu
- Department of Clinical Pathology and Medical Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
- Correspondence:
| | - Kuo-Cheng Lu
- Department of Medical Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (K.-W.T.); (K.-C.L.)
- Division of Nephrology, Department of Medicine, Fu-Jen Catholic University Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City 243, Taiwan
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14
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Watson N, Hermann P, Ladogana A, Denouel A, Baiardi S, Colaizzo E, Giaccone G, Glatzel M, Green AJE, Haïk S, Imperiale D, MacKenzie J, Moda F, Smith C, Summers D, Tiple D, Vaianella L, Zanusso G, Pocchiari M, Zerr I, Parchi P, Brandel JP, Pal S. Validation of Revised International Creutzfeldt-Jakob Disease Surveillance Network Diagnostic Criteria for Sporadic Creutzfeldt-Jakob Disease. JAMA Netw Open 2022; 5:e2146319. [PMID: 35099544 PMCID: PMC8804913 DOI: 10.1001/jamanetworkopen.2021.46319] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Sporadic Creutzfeldt-Jakob disease (sCJD) is a rapidly lethal disease. Rapid, accurate diagnosis is imperative for epidemiological surveillance and public health activities to exclude treatable differentials and facilitate supportive care. In 2017, the International CJD Surveillance Network diagnostic criteria were revised to incorporate cortical ribboning on magnetic resonance imaging and the real-time quaking-induced conversion (RT-QuIC) assay, developments that require multicenter evaluation. OBJECTIVE To evaluate the accuracy of revised diagnostic criteria through the retrospective diagnosis of autopsy-confirmed cases (referred to as in-life diagnosis). DESIGN, SETTING, AND PARTICIPANTS This diagnostic study used a 3-year clinicopathological series using all cases of autopsy-confirmed sCJD and a noncase group with alternative neuropathological diagnoses from national surveillance centers in the United Kingdom, France, Germany, and Italy. Data were collected from January 2017 to December 2019 and analyzed from January 2020 to November 2021. MAIN OUTCOMES AND MEASURES Sensitivity and specificity of revised diagnostic criteria and diagnostic investigations. Secondary analyses assessing sCJD subgroups by genotype, pathological classification, disease duration, and age. RESULTS A total of 501 sCJD cases and 146 noncases were included. Noncase diagnoses included neurodegenerative diseases, autoimmune encephalitis, and cerebral insults such as anoxia. Participants in the sCJD cases cohort were younger (mean [SD] age, 68.8 [9.8] years vs 72.8 [10.9] years; P < .001) and had longer median (IQR) disease duration (118 [74.8-222.3] days vs 85 [51.5-205.5] days; P = .002); sex ratios were equivalent (253 [50.5%] male cases vs 74 [50.7%] male noncases). Sensitivity of revised criteria in in-life diagnosis (450 of 488 [92.2%] diagnoses; 95% CI, 89.5%-94.4%) was increased compared with prior criteria (378 of 488 [77.5%] diagnoses; 95% CI, 73.5%-81.1%; P < .001), while specificity (101 of 125 [80.8%] diagnoses; 95% CI, 72.8%-87.3%) was unchanged (102 of 125 [81.6%] diagnoses; 95% CI, 73.7%-88.0%; P > .99). Among 223 cases and 52 noncases with the full panel of investigations performed, sensitivity of revised criteria (97.8%; 95% CI, 94.9%-99.3%) was increased compared with prior criteria (76.2%; 95% CI, 70.1%-81.7%; P < .001) while specificity was unchanged (67.3%; 95% CI, 52.9%-79.7% vs 69.2%; 95% CI, 54.9%-81.3%; P > .99). In 455 cases and 111 noncases, cortical ribboning was 67.9% sensitive (95% CI, 63.4%-72.2%) and 86.5% specific (95% CI, 78.7%-92.2%). In 274 cases and 77 noncases, RT-QuIC was 91.6% sensitive (95% CI, 87.7%-94.6%) and 100% specific (95% CI, 96.2%-100%). Investigation sensitivity varied with genetic and pathological features, disease duration, and age. CONCLUSIONS AND RELEVANCE This diagnostic study demonstrated significantly improved sensitivity of revised sCJD diagnostic criteria with unaltered specificity. The revision has enhanced diagnostic accuracy for clinical care and surveillance.
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Affiliation(s)
- Neil Watson
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Hermann
- National Reference Centre for TSE, Department of Neurology, University Medical Centre Göttingen, Göttingen, Germany
| | - Anna Ladogana
- Registry of Creutzfeldt-Jakob Disease, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Angeline Denouel
- Cellule Nationale de référence des MCJ, Groupe Hospitalier Pitié-Salpêtrière, Paris Cedex 13, France
| | - Simone Baiardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Elisa Colaizzo
- Registry of Creutzfeldt-Jakob Disease, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Giorgio Giaccone
- Neurology 5/Neuropathology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alison J. E. Green
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Stéphane Haïk
- Cellule Nationale de référence des MCJ, Groupe Hospitalier Pitié-Salpêtrière, Paris Cedex 13, France
| | | | - Janet MacKenzie
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Fabio Moda
- Neurology 5/Neuropathology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Colin Smith
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - David Summers
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Dorina Tiple
- Registry of Creutzfeldt-Jakob Disease, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Luana Vaianella
- Registry of Creutzfeldt-Jakob Disease, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Verona, Italy
| | - Maurizio Pocchiari
- Registry of Creutzfeldt-Jakob Disease, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Inga Zerr
- National Reference Centre for TSE, Department of Neurology, University Medical Centre Göttingen, Göttingen, Germany
| | - Piero Parchi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Jean-Philippe Brandel
- Cellule Nationale de référence des MCJ, Groupe Hospitalier Pitié-Salpêtrière, Paris Cedex 13, France
| | - Suvankar Pal
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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15
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Tayyebi G, Malakouti SK, Shariati B, Kamalzadeh L. COVID-19-associated encephalitis or Creutzfeldt-Jakob disease: a case report. Neurodegener Dis Manag 2021; 12:29-34. [PMID: 34854312 PMCID: PMC8765092 DOI: 10.2217/nmt-2021-0025] [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] [Indexed: 12/13/2022] Open
Abstract
Background: Accurate diagnosis and management of patients with rapidly progressive dementia may be challenging during the COVID-19 pandemic, which has negatively influenced the diagnostic performances, medical resource allocation and routine care for all non-COVID-19 diseases. Case Presentation: We herein present a case of a 57‐year‐old male with rapidly progressive cognitive decline, headache, diplopia, myalgia, unsteady gait, aggression, depression, insomnia, hallucinations and delusions of persecution. COVID-19-associated encephalitis was briefly considered as a differential diagnosis. However, this hypothesis was rejected upon further investigation. A final diagnosis of sporadic Creutzfeldt–Jakob disease was made. Conclusion: A timely and accurate diagnosis of Creutzfeldt–Jakob disease gives patients and their families the chance to receive a good standard of healthcare and avoid extensive evaluations for other conditions.
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Affiliation(s)
- Gooya Tayyebi
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Malakouti
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Shariati
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Kamalzadeh
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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16
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Ziukelis ET, Sharma VK, Gome JJ. Premortem diagnosis of pathologically confirmed sporadic Creutzfeldt-Jakob disease. Clin Case Rep 2021; 9:e04461. [PMID: 34322245 PMCID: PMC8299091 DOI: 10.1002/ccr3.4461] [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] [Received: 12/22/2020] [Revised: 05/21/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease should be considered in any case of rapid neuropsychiatric decline. While neuropathological examination of a brain biopsy specimen remains the only definitive diagnostic method and real-time quaking-induced conversion tests have simplified premortem diagnosis, careful evaluation of magnetic resonance imaging can provide readily accessible clues.
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Affiliation(s)
| | - Vasu Keshav Sharma
- South West HealthcareWarrnamboolVicAustralia
- Health Imaging ServicesWarrnamboolVicAustralia
| | - James J Gome
- South West HealthcareWarrnamboolVicAustralia
- Deakin UniversityBurwoodVicAustralia
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17
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Younes K, Rojas JC, Wolf A, Sheng‐Yang GM, Paoletti M, Toller G, Caverzasi E, Luisa Mandelli M, Illán‐Gala I, Kramer JH, Cobigo Y, Miller BL, Rosen HJ, Geschwind MD. Selective vulnerability to atrophy in sporadic Creutzfeldt-Jakob disease. Ann Clin Transl Neurol 2021; 8:1183-1199. [PMID: 33949799 PMCID: PMC8164858 DOI: 10.1002/acn3.51290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/16/2020] [Accepted: 12/04/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Identification of brain regions susceptible to quantifiable atrophy in sporadic Creutzfeldt-Jakob disease (sCJD) should allow for improved understanding of disease pathophysiology and development of structural biomarkers that might be useful in future treatment trials. Although brain atrophy is not usually present by visual assessment of MRIs in sCJD, we assessed whether using voxel-based morphometry (VBM) can detect group-wise brain atrophy in sCJD. METHODS 3T brain MRI data were analyzed with VBM in 22 sCJD participants and 26 age-matched controls. Analyses included relationships of regional brain volumes with major clinical variables and dichotomization of the cohort according to expected disease duration based on prion molecular classification (i.e., short-duration/Fast-progressors (MM1, MV1, and VV2) vs. long-duration/Slow-progressors (MV2, VV1, and MM2)). Structural equation modeling (SEM) was used to assess network-level interactions of atrophy between specific brain regions. RESULTS sCJD showed selective atrophy in cortical and subcortical regions overlapping with all but one region of the default mode network (DMN) and the insulae, thalami, and right occipital lobe. SEM showed that the effective connectivity model fit in sCJD but not controls. The presence of visual hallucinations correlated with right fusiform, bilateral thalami, and medial orbitofrontal atrophy. Interestingly, brain atrophy was present in both Fast- and Slow-progressors. Worse cognition was associated with bilateral mesial frontal, insular, temporal pole, thalamus, and cerebellum atrophy. INTERPRETATION Brain atrophy in sCJD preferentially affects specific cortical and subcortical regions, with an effective connectivity model showing strength and directionality between regions. Brain atrophy is present in Fast- and Slow-progressors, correlates with clinical findings, and is a potential biomarker in sCJD.
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Affiliation(s)
- Kyan Younes
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Julio C. Rojas
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Amy Wolf
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Goh M. Sheng‐Yang
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Matteo Paoletti
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
- Advanced Imaging and Radiomics CenterNeuroradiology DepartmentIRCCS Mondino FoundationPaviaItaly
| | - Gianina Toller
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Eduardo Caverzasi
- Department of NeurologyUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Maria Luisa Mandelli
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Ignacio Illán‐Gala
- Department of NeurologyHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Joel H. Kramer
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Yann Cobigo
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Bruce L. Miller
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Howard J. Rosen
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Michael D. Geschwind
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
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18
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Kotkowski E, Cabot JH, Lacci JV, Payne DH, Cavazos JE, Romero RS, Seifi A. Creutzfeldt-Jakob Disease: In-hospital demographics report of national data in the United States from 2016 and review of a rapidly-progressive case. Clin Neurol Neurosurg 2020; 197:106103. [PMID: 32717558 PMCID: PMC7703375 DOI: 10.1016/j.clineuro.2020.106103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND This report highlights a rapidly progressive case of Creutzfeldt-Jakob Disease (CJD) whose time from symptom onset to death spanned less than two months. We also explore the most recently available in-patient demographics data for discharges with CJD in the United States. METHODS We reviewed a CJD case and systematically analyzed a retrospective cohort of CJD discharges using the Healthcare Cost and Utilization Project (HCUP) to evaluate the existing national data on the status of CJD demographics and dispositions in the United States in 2016. RESULTS An estimated total of 710 hospital discharges with a diagnosis of CJD were seen across the United States in 2016. According to HCUP, the average age of patients was 66.15 ± 11.54 years with 48.6 % female. Average time to intubation from admission to hospital was 4.71 ± 7.32 days with a rate of intubation of 6.34 %. The mean hospital cost was $19,901.25 ± $18,743.48. The rate of in-hospital mortality was 8.45 %. No significant geographical differences were noted (p = 0.49). No significant differences were seen among incidence in specific ethnic groups (p = 0.33) or income quartiles (p = 0.90). CONCLUSIONS Our data shows that the incidence of CJD in 2016 appears to be equally distributed among individuals in the United States by demographic categories. Additionally, our case-study from 2019 illustrates an important example for diagnosing a rapidly-progressing case of CJD.
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Affiliation(s)
- Eithan Kotkowski
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; University of Texas Health Science Center at San Antonio Long School of Medicine, San Antonio, TX, USA
| | - John H Cabot
- University of Texas Health Science Center at San Antonio Long School of Medicine, San Antonio, TX, USA
| | - John V Lacci
- University of Texas Health Science Center at San Antonio Long School of Medicine, San Antonio, TX, USA
| | - Davis H Payne
- University of Texas Health Science Center at San Antonio Long School of Medicine, San Antonio, TX, USA
| | - Jose E Cavazos
- University of Texas Health Science Center at San Antonio Long School of Medicine, San Antonio, TX, USA; University of Texas Health Science Center at San Antonio Department of Neurology, San Antonio, TX, USA
| | - Rebecca S Romero
- University of Texas Health Science Center at San Antonio Long School of Medicine, San Antonio, TX, USA; University of Texas Health Science Center at San Antonio Department of Neurology, San Antonio, TX, USA; Comprehensive Multiple Sclerosis Clinic at the University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ali Seifi
- University of Texas Health Science Center at San Antonio Long School of Medicine, San Antonio, TX, USA; Department of Neurosurgery, Neurology, and Anesthesiology at University Health System, San Antonio, TX, USA.
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19
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Zhang YL, Wu XM, Chen Y, Gu WP, Lu W. Could Sporadic Creutzfeldt-Jakob Disease Be Underdiagnosed in China? Experience From Four Cases. Front Neurol 2020; 11:763. [PMID: 32849219 PMCID: PMC7399133 DOI: 10.3389/fneur.2020.00763] [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: 12/11/2019] [Accepted: 06/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Creutzfeldt-Jakob Disease (CJD) is a rapidly progressive neurodegenerative disease caused by the misfolded version of the cellular prion protein. Here we report four cases of sporadic CJD (sCJD) and describe the diagnostic methods available in order avoid missed or delayed recognition of CJD in China. Case presentation: We report four patients diagnosed with sCJD between March 2018 and December 2019 at Xiangya Hospital and the Second Xiangya Hospital of Central South University. All patients were admitted to the hospital because of a progressive cognitive decline. Although their routine tests and biochemical indicators in the cerebrospinal fluid (CSF), as well as computed tomography (CT) imaging, did not reveal any apparent abnormalities, the presence of “cortical ribboning” was incidentally found on diffusion-weighted imaging (DWI). The patients were subsequently diagnosed with CJD based on positive testing for 14-3-3 protein in their CSF, and the presence of periodic sharp and slow wave complexes (PSWCs) on their electroencephalograms (EEG). Additionally, two of patients was confirmed pathological examination of cerebral biopsies demonstrating neuronal loss, gliosis, and spongiform changes. Conclusions: CJD is a rare disease and is easily misdiagnosed by clinician in China due to a lack of recognition and awareness of CJD. Based on our experience described in this report, enhanced vigilance for CJD is required for patients with rapidly progressive dementia in China and other developing countries. DWI, EEG and detection of 14-3-3 protein in CSF should be performed in order to achieve a timely diagnosis of CJD.
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Affiliation(s)
- Yi-Liu Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-Mei Wu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Chen
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen-Ping Gu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Wen-Ping Gu
| | - Wei Lu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- Wei Lu
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20
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Towards a treatment for genetic prion disease: trials and biomarkers. Lancet Neurol 2020; 19:361-368. [PMID: 32199098 DOI: 10.1016/s1474-4422(19)30403-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 01/19/2023]
Abstract
Prion disease is a rare, fatal, and exceptionally rapid neurodegenerative disease. Although incurable, prion disease follows a clear pathogenic mechanism, in which a single gene gives rise to a single prion protein (PrP) capable of converting into the sole causal disease agent, the misfolded prion. As efforts progress to leverage this mechanistic knowledge toward rational therapies, a principal challenge will be the design of clinical trials. Previous trials in prion disease have been done in symptomatic patients who are often profoundly debilitated at enrolment. About 15% of prion disease cases are genetic, creating an opportunity for early therapeutic intervention to delay or prevent disease. Highly variable age of onset and absence of established prodromal biomarkers might render infeasible existing models for testing drugs before disease onset. Advancement of near-term targeted therapeutics could crucially depend on thoughtful design of rigorous presymptomatic trials.
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21
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Kharel H, Adhikari P, Pokhrel NB, Kharel Z, Nepal G. The first reported case of Creutzfeldt-Jakob disease from Nepal. Clin Case Rep 2020; 8:198-202. [PMID: 31998516 PMCID: PMC6982523 DOI: 10.1002/ccr3.2609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/10/2019] [Accepted: 11/21/2019] [Indexed: 12/27/2022] Open
Abstract
Creutzfeldt-Jakob disease (CJD) can also be diagnosed in a resource-limited setting through good clinical analysis. The diagnosis of CJD should be considered in patients with rapidly evolving neurological signs associated with cognitive disturbances even in countries with limited available sophisticated tools and where CJD was never reported before.
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Affiliation(s)
- Himal Kharel
- Tribhuvan University Institute of MedicineKathmanduNepal
| | | | | | - Zeni Kharel
- Department of Internal MedicineRochester General HospitalRochesterNYUSA
| | - Gaurav Nepal
- Tribhuvan University Institute of MedicineKathmanduNepal
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22
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Appleby BS, Glisic K, Rhoads DD, Bizzi A, Cohen ML, Mahajan S. Feasibility of Remote Assessment of Human Prion Diseases for Research and Surveillance. Dement Geriatr Cogn Disord 2019; 47:79-90. [PMID: 30861521 DOI: 10.1159/000497055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prion disease research and surveillance can be challenging due to the disease's difficulty to diagnose, rapid progression, and geographic dispersion. Improving accessibility through teleneurology could improve the ability to conduct these activities. OBJECTIVES The aim of this study was to determine the feasibility of conducting teleneurology assessments for research and surveillance of prion diseases. METHOD Participants were offered in-person visit, medical record review, or teleneurology assessment. Standardized histories and assessments evaluating cognition, functional ability, and neuropsychiatric symptoms were collected. Data regarding participants' satisfaction with teleneurology were collected. RESULTS From April 2017 to July 2018, the study received 114 referrals. 45 and 5 participants consented for the teleneurology and medical record review arms of the study, respectively. 29 subjects participated in at least one teleneurology visit. Participants expressed satisfaction with teleneurology and found it easy to participate. Some aspects of the examination were hindered or interrupted due to technological reasons. CONCLUSIONS We demonstrate the feasibility and preference of teleneurology as a modality in which subjects with prion disease can partake in clinical research. Technological aspects sometimes interfered with research assessments.
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Affiliation(s)
- Brian S Appleby
- Departments of Neurology and Psychiatry, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA, .,Department of Pathology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA, .,National Prion Disease Pathology Surveillance Center, Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA,
| | - Kathleen Glisic
- Department of Pathology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,National Prion Disease Pathology Surveillance Center, Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Daniel D Rhoads
- Department of Pathology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,National Prion Disease Pathology Surveillance Center, Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alberto Bizzi
- Neuroradiology Unit, Fondazione Istituto Neurologico Carlo Besta IRCCS, Milano, Italy
| | - Mark L Cohen
- Department of Pathology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,National Prion Disease Pathology Surveillance Center, Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA
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23
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Cerebrospinal fluid non-phosphorylated tau in the differential diagnosis of Creutzfeldt–Jakob disease: a comparative prospective study with 14-3-3. J Neurol 2019; 267:543-550. [DOI: 10.1007/s00415-019-09610-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022]
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24
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Clinical Presentation of Sporadic Creutzfeldt-Jakob Disease in Han-Chinese. Alzheimer Dis Assoc Disord 2019; 34:188-190. [PMID: 31651418 DOI: 10.1097/wad.0000000000000350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The clinical presentation in Chinese patients with sporadic Creutzfeldt-Jakob disease (sCJD) may be unique due to the big difference in the codon 129 polymorphism of the prion protein gene (PRNP). This study retrospectively reviewed 26 cases of sCJD diagnosed in a single center in recent years. All 26 sCJD patients received brain magnetic resonance imaging scan, cerebrospinal fluid 14-3-3 protein detection, electroencephalogram, and PRNP gene screening. The codon 129 polymorphism were all homozygous MM in 26 sCJD patients. The main onset symptoms of sCJD patients were rapidly progressive dementia, visual impairment, and cerebellar ataxia. At the time of diagnosis, the incidence of myoclonus and akinetic mutism were relatively low (<50%). For auxiliary examinations, the positive rate of the typical magnetic resonance imaging (MRI) abnormalities, cerebrospinal fluid 14-3-3 protein, and electroencephalogram-periodic sharp wave complex was 96%, 64%, and 50%, respectively. As MM genotype is dominant and brain MRI is sensitive, brain MRI seems to play a major role in diagnosis of sCJD in Chinese.
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25
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Raymond GJ, Zhao HT, Race B, Raymond LD, Williams K, Swayze EE, Graffam S, Le J, Caron T, Stathopoulos J, O'Keefe R, Lubke LL, Reidenbach AG, Kraus A, Schreiber SL, Mazur C, Cabin DE, Carroll JB, Minikel EV, Kordasiewicz H, Caughey B, Vallabh SM. Antisense oligonucleotides extend survival of prion-infected mice. JCI Insight 2019; 5:131175. [PMID: 31361599 PMCID: PMC6777807 DOI: 10.1172/jci.insight.131175] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Prion disease is a fatal, incurable neurodegenerative disease of humans and other mammals caused by conversion of cellular prion protein (PrPC) into a self-propagating neurotoxic conformer (prions; PrPSc). Strong genetic proofs of concept support lowering PrP expression as a therapeutic strategy. Antisense oligonucleotides (ASOs) can provide a practical route to lowering 1 target mRNA in the brain, but their development for prion disease has been hindered by 3 unresolved issues from prior work: uncertainty about mechanism of action, unclear potential for efficacy against established prion infection, and poor tolerability of drug delivery by osmotic pumps. Here, we test ASOs delivered by bolus intracerebroventricular injection to intracerebrally prion-infected WT mice. Prophylactic treatments given every 2–3 months extended survival times 61%–98%, and a single injection at 120 days after infection, near the onset of clinical signs, extended survival 55% (87 days). In contrast, a nontargeting control ASO was ineffective. Thus, PrP lowering is the mechanism of action of ASOs effective against prion disease in vivo, and infrequent — or even single — bolus injections of ASOs can slow prion neuropathogenesis and markedly extend survival, even when initiated near clinical signs. These findings should empower development of PrP-lowering therapy for prion disease. ASO-mediated prion protein suppression delays disease and extends survival, even in mice with established prion infection.
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Affiliation(s)
- Gregory J Raymond
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, NIH, Hamilton, Montana, USA
| | | | - Brent Race
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, NIH, Hamilton, Montana, USA
| | - Lynne D Raymond
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, NIH, Hamilton, Montana, USA
| | - Katie Williams
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, NIH, Hamilton, Montana, USA
| | - Eric E Swayze
- Ionis Pharmaceuticals Inc., Carlsbad, California, USA
| | - Samantha Graffam
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Jason Le
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Tyler Caron
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | | | - Rhonda O'Keefe
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Lori L Lubke
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, NIH, Hamilton, Montana, USA
| | | | - Allison Kraus
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, NIH, Hamilton, Montana, USA
| | | | - Curt Mazur
- Ionis Pharmaceuticals Inc., Carlsbad, California, USA
| | | | | | - Eric Vallabh Minikel
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, NIH, Hamilton, Montana, USA.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, Massachusetts, USA.,Prion Alliance, Cambridge, Massachusetts, USA
| | | | - Byron Caughey
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, NIH, Hamilton, Montana, USA
| | - Sonia M Vallabh
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, NIH, Hamilton, Montana, USA.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, Massachusetts, USA.,Prion Alliance, Cambridge, Massachusetts, USA
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26
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Chronic Wasting Disease in Cervids: Implications for Prion Transmission to Humans and Other Animal Species. mBio 2019; 10:mBio.01091-19. [PMID: 31337719 PMCID: PMC6650550 DOI: 10.1128/mbio.01091-19] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic wasting disease (CWD) is a prion-related transmissible spongiform encephalopathy of cervids, including deer, elk, reindeer, sika deer, and moose. CWD has been confirmed in at least 26 U.S. states, three Canadian provinces, South Korea, Finland, Norway, and Sweden, with a notable increase in the past 5 years. The continued geographic spread of this disease increases the frequency of exposure to CWD prions among cervids, humans, and other animal species. Chronic wasting disease (CWD) is a prion-related transmissible spongiform encephalopathy of cervids, including deer, elk, reindeer, sika deer, and moose. CWD has been confirmed in at least 26 U.S. states, three Canadian provinces, South Korea, Finland, Norway, and Sweden, with a notable increase in the past 5 years. The continued geographic spread of this disease increases the frequency of exposure to CWD prions among cervids, humans, and other animal species. Since CWD is now an established wildlife disease in North America, proactive steps, where possible, should be taken to limit transmission of CWD among animals and reduce the potential for human exposure.
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27
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Liang Y, Li Y, Wang H, Cheng X, Guan M, Zhong S, Zhao C. Does the Use of Antidepressants Accelerate the Disease Progress in Creutzfeldt-Jakob Disease Patients With Depression? A Case Report and A Systematic Review. Front Psychiatry 2019; 10:297. [PMID: 31130883 PMCID: PMC6509196 DOI: 10.3389/fpsyt.2019.00297] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/16/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disorder characterized by rapidly progressive dementia. Growing evidence suggests that antidepressant usage was associated with dementia. Given the commonality of depression in CJD, it is necessary to investigate the effect of antidepressants on CJD. Methods: First, we report a case of sporadic CJD (sCJD) with depression where the condition worsened rapidly after using a serotonin and noradrenaline reuptake inhibitor (SNRI) antidepressant. Second, a systematic literature survey was conducted to investigate the effect of antidepressants on the survival time of sCJD patients with depression. Thirteen cases plus our case were included for qualitative analysis. Twelve subjects were included in the Kaplan-Meier survival and Cox regression analysis. Finally, we provide a postulation of pathophysiological mechanism in CJD. Results: The median survival time of all patients was 6.0 months, of which patients with SNRIs were significantly shorter than those with first-generation antidepressants (2.0 vs. 6.0 months; log rank, P = .008) and relatively shorter than those with nonselective serotonin reuptake inhibitors (SSRIs; 4.0 vs. 6.0 months; log rank, P = .090). In comparison with first-generation antidepressants, the use of SNRIs [hazard ratio (HR), 23.028; 95% confidence interval (CI), 1.401 to 378.461; P = .028] remained independently associated with shorter survival time. Conclusions: The use of antidepressants, especially SNRIs, was associated with a shorter survival time of sCJD patients. The possible changes in neurotransmitters should be emphasized. Scientifically, this study may provide insights into the mechanism of CJD. Clinically, it may contribute to the early diagnosis of CJD.
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Affiliation(s)
- Yifan Liang
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Yan Li
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Huibin Wang
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Xi Cheng
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Meiting Guan
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Shanshan Zhong
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Chuansheng Zhao
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
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28
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Orrù CD, Soldau K, Cordano C, Llibre-Guerra J, Green AJ, Sanchez H, Groveman BR, Edland SD, Safar JG, Lin JH, Caughey B, Geschwind MD, Sigurdson CJ. Prion Seeds Distribute throughout the Eyes of Sporadic Creutzfeldt-Jakob Disease Patients. mBio 2018; 9:e02095-18. [PMID: 30459197 PMCID: PMC6247090 DOI: 10.1128/mbio.02095-18] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 12/16/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is the most common prion disease in humans and has been iatrogenically transmitted through corneal graft transplantation. Approximately 40% of sCJD patients develop visual or oculomotor symptoms and may seek ophthalmological consultation. Here we used the highly sensitive real-time quaking-induced conversion (RT-QuIC) assay to measure postmortem prion seeding activities in cornea, lens, ocular fluid, retina, choroid, sclera, optic nerve, and extraocular muscle in the largest series of sCJD patient eyes studied by any assay to date. We detected prion seeding activity in 100% of sCJD eyes, representing three common sCJD subtypes, with levels varying by up to 4 log-fold among individuals. The retina consistently showed the highest seed levels, which in some cases were only slightly lower than brain. Within the retina, prion deposits were detected by immunohistochemistry (IHC) in the retinal outer plexiform layer in most sCJD cases, and in some eyes the inner plexiform layer, consistent with synaptic prion deposition. Prions were not detected by IHC in any other eye region. With RT-QuIC, prion seed levels generally declined in eye tissues with increased distance from the brain, and yet all corneas had prion seeds detectable. Prion seeds were also present in the optic nerve, extraocular muscle, choroid, lens, vitreous, and sclera. Collectively, these results reveal that sCJD patients accumulate prion seeds throughout the eye, indicating the potential diagnostic utility as well as a possible biohazard.IMPORTANCE Cases of iatrogenic prion disease have been reported from corneal transplants, yet the distribution and levels of prions throughout the eye remain unknown. This study probes the occurrence, level, and distribution of prions in the eyes of patients with sporadic Creutzfeldt-Jakob disease (sCJD). We tested the largest series of prion-infected eyes reported to date using an ultrasensitive technique to establish the prion seed levels in eight regions of the eye. All 11 cases had detectable prion seeds in the eye, and in some cases, the seed levels in the retina approached those in brain. In most cases, prion deposits could also be seen by immunohistochemical staining of retinal tissue; other ocular tissues were negative. Our results have implications for estimating the risk for iatrogenic transmission of sCJD as well as for the development of antemortem diagnostic tests for prion diseases.
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Affiliation(s)
- Christina D Orrù
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, Montana, USA
| | - Katrin Soldau
- Department of Pathology, University of California, San Diego, La Jolla, California, USA
| | - Christian Cordano
- Department of Neurology, Multiple Sclerosis Center, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Jorge Llibre-Guerra
- Cognitive and Behavioral Research Unit, National Institute of Neurology, Havana, Cuba
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Ari J Green
- Department of Neurology, Multiple Sclerosis Center, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Henry Sanchez
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Bradley R Groveman
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, Montana, USA
| | - Steven D Edland
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, California, USA
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Jiri G Safar
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jonathan H Lin
- Department of Pathology, University of California, San Diego, La Jolla, California, USA
| | - Byron Caughey
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, Montana, USA
| | - Michael D Geschwind
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Christina J Sigurdson
- Department of Pathology, University of California, San Diego, La Jolla, California, USA
- Department of Pathology, Immunology, and Microbiology, University of California, Davis, Davis, California, USA
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29
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An Evaluation of Rapidly Progressive Dementia Culminating in a Diagnosis of Creutzfeldt-Jakob Disease. Case Rep Infect Dis 2018; 2018:2374179. [PMID: 30345127 PMCID: PMC6174731 DOI: 10.1155/2018/2374179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/11/2018] [Accepted: 09/03/2018] [Indexed: 11/18/2022] Open
Abstract
Rapidly progressive dementia is a curious and elusive clinical description of a pattern of cognitive deficits that progresses faster than typical dementia syndromes. The differential diagnosis and clinical workup for rapidly progressive dementia are quite extensive and involve searching for infectious, inflammatory, autoimmune, neoplastic, metabolic, and neurodegenerative causes. We present the case of a previously highly functional 76-year-old individual who presented with a 6-month history of rapidly progressive dementia. His most prominent symptoms were cognitive impairment, aphasia, visual hallucinations, and ataxia. Following an extensive battery of tests in hospital, the differential diagnosis remained probable CJD versus autoimmune encephalitis. He clinically deteriorated and progressed to akinetic mutism and myoclonus. He passed away 8 weeks after his initial presentation to hospital, and an autopsy confirmed a diagnosis of sporadic CJD. We use this illustrative case as a framework to discuss the clinical and diagnostic considerations in the workup for rapidly progressive dementia. We also discuss CJD and autoimmune encephalitis, the two main diagnostic possibilities in our patient, in more detail.
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30
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Rapidly Progressive Dementia: Prevalence and Causes in a Neurologic Unit of a Tertiary Hospital in Brazil. Alzheimer Dis Assoc Disord 2018; 31:239-243. [PMID: 27849640 DOI: 10.1097/wad.0000000000000170] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rapidly progressive dementia (RPD) is usually associated with Creutzfeldt-Jakob disease, a fatal condition. Current advances in the understanding of immune-mediated diseases allow the diagnosis of previously unrecognized treatable RPDs. OBJECTIVE OF THE STUDY The objective of the study was to describe the prevalence and causes of RPD in a neurology service, identifying potentially reversible causes. METHODS We carried out a cross-sectional evaluation of all patients admitted to the neurology unit of a tertiary hospital in Brazil between March 2012 and February 2015. We included patients who had progressed to moderate or severe dementia within a few months or up to 2 years at the time of hospitalization, and used multivariable logistic regression analysis to identify factors associated with a favorable outcome. RESULTS We identified 61 RPD (3.7%) cases among 1648 inpatients. Mean RPD patients' age was 48 years, and median time to progression was 6.4 months. Immune-mediated diseases represented the most commonly observed disease group in this series (45.9% of cases). Creutzfeldt-Jakob disease (11.5%) and nonprion neurodegenerative diseases (8.2%) were less common in this series. Outcome was favorable in 36/61 (59.0%) RPD cases and in 28/31 (89.3%) of immune-mediated cases. Favorable outcome was associated with shorter time from symptom onset to diagnosis and abnormal cerebrospinal fluid findings. CONCLUSIONS Immune-mediated diseases were the most common cause of RPD in this series. Timely evaluation and diagnosis along with institution of appropriate therapy are required in RPD, especially in view of potentially reversible causes.
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31
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Peckeu L, Delasnerie-Lauprètre N, Brandel JP, Salomon D, Sazdovitch V, Laplanche JL, Duyckaerts C, Seilhean D, Haïk S, Hauw JJ. Accuracy of diagnosis criteria in patients with suspected diagnosis of sporadic Creutzfeldt-Jakob disease and detection of 14-3-3 protein, France, 1992 to 2009. ACTA ACUST UNITED AC 2018; 22. [PMID: 29043964 PMCID: PMC5710122 DOI: 10.2807/1560-7917.es.2017.22.41.16-00715] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Diagnostic criteria of Creutzfeldt–Jakob disease (CJD), a rare and fatal transmissible nervous system disease with public health implications, are determined by clinical data, electroencephalogram (EEG), detection of 14-3-3 protein in cerebrospinal fluid (CSF), brain magnetic resonance imaging and prion protein gene examination. The specificity of protein 14-3-3 has been questioned. We reviewed data from 1,572 autopsied patients collected over an 18-year period (1992–2009) and assessed whether and how 14-3-3 detection impacted the diagnosis of sporadic CJD in France, and whether this led to the misdiagnosis of treatable disorders. 14-3-3 detection was introduced into diagnostic criteria for CJD in 1998. Diagnostic accuracy decreased from 92% for the 1992–1997 period to 85% for the 1998–2009 period. This was associated with positive detections of 14-3-3 in cases with negative EEG and alternative diagnosis at autopsy. Potentially treatable diseases were found in 163 patients (10.5%). This study confirms the usefulness of the recent modification of diagnosis criteria by the addition of the results of CSF real-time quaking-induced conversion, a method based on prion seed-induced misfolding and aggregation of recombinant prion protein substrate that has proven to be a highly specific test for diagnosis of sporadic CJD.
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Affiliation(s)
- Laurene Peckeu
- Assistance publique-Hôpitaux de Paris (AP-HP), Cellule nationale de référence des maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), U1127, Paris, France.,Institut du cerveau et de la moelle épinière (ICM), Paris, France.,These authors contributed equally to this study and share first authorship.,Sorbonne Universités, UPMCUniv Paris 06,UMRS 1127, Paris, France
| | - Nicole Delasnerie-Lauprètre
- These authors contributed equally to this study and share first authorship.,Sorbonne Universités, UPMCUniv Paris 06,UMRS 1127, Paris, France.,Assistance publique-Hôpitaux de Paris (AP-HP), Cellule nationale de référence des maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), U1127, Paris, France.,Institut du cerveau et de la moelle épinière (ICM), Paris, France
| | - Jean-Philippe Brandel
- Assistance publique-Hôpitaux de Paris (AP-HP), Cellule nationale de référence des maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Institut du cerveau et de la moelle épinière (ICM), Paris, France.,Sorbonne Universités, UPMCUniv Paris 06,UMRS 1127, Paris, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), U1127, Paris, France
| | - Dominique Salomon
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unité Mixte de Recherche (UMR) 1153, Paris, France
| | - Véronique Sazdovitch
- Assistance publique-Hôpitaux de Paris (AP-HP), Laboratoire de Neuropathologie Raymond Escourolle, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Institut du cerveau et de la moelle épinière (ICM), Paris, France.,Sorbonne Universités, UPMCUniv Paris 06,UMRS 1127, Paris, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), U1127, Paris, France
| | - Jean-Louis Laplanche
- Assistance publique-Hôpitaux de Paris (AP-HP), Service de Biochimie et Biologie Moléculaire, Hôpital Lariboisière; Université Paris Descartes, Paris, France
| | - Charles Duyckaerts
- Assistance publique-Hôpitaux de Paris (AP-HP), Laboratoire de Neuropathologie Raymond Escourolle, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Institut du cerveau et de la moelle épinière (ICM), Paris, France.,Sorbonne Universités, UPMCUniv Paris 06,UMRS 1127, Paris, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), U1127, Paris, France
| | - Danielle Seilhean
- Assistance publique-Hôpitaux de Paris (AP-HP), Laboratoire de Neuropathologie Raymond Escourolle, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Institut du cerveau et de la moelle épinière (ICM), Paris, France.,Sorbonne Universités, UPMCUniv Paris 06,UMRS 1127, Paris, France.,Institut National de la Santé et de la Recherche Médicale (Inserm), U1127, Paris, France
| | - Stéphane Haïk
- Institut National de la Santé et de la Recherche Médicale (Inserm), U1127, Paris, France.,Assistance publique-Hôpitaux de Paris (AP-HP), Laboratoire de Neuropathologie Raymond Escourolle, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Assistance publique-Hôpitaux de Paris (AP-HP), Cellule nationale de référence des maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Sorbonne Universités, UPMCUniv Paris 06,UMRS 1127, Paris, France.,Institut du cerveau et de la moelle épinière (ICM), Paris, France
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32
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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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33
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Geschwind MD, Murray K. Differential diagnosis with other rapid progressive dementias in human prion diseases. HANDBOOK OF CLINICAL NEUROLOGY 2018; 153:371-397. [PMID: 29887146 DOI: 10.1016/b978-0-444-63945-5.00020-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Prion diseases are unique in medicine as in humans they occur in sporadic, genetic, and acquired forms. The most common human prion disease is sporadic Creutzfeldt-Jakob disease (CJD), which commonly presents as a rapidly progressive dementia (RPD) with behavioral, cerebellar, extrapyramidal, and some pyramidal features, with the median survival from symptom onset to death of just a few months. Because human prion diseases, as well as other RPDs, are relatively rare, they can be difficult to diagnose, as most clinicians have seen few, if any, cases. Not only can prion diseases mimic many other conditions that present as RPD, but some of those conditions can present similarly to prion disease. In this article, the authors discuss the different etiologic categories of conditions that often present as RPD and also present RPDs that had been misdiagnosed clinically as CJD. Etiologic categories of conditions are presented in order of the mnemonic used for remembering the various categories of RPDs: VITAMINS-D, for vascular, infectious, toxic-metabolic, autoimmune, mitochondrial/metastases, iatrogenic, neurodegenerative, system/seizures/sarcoid, and demyelinating. When relevant, clinical, imaging, or other features of an RPD that overlap with those of CJD are presented.
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Affiliation(s)
- Michael D Geschwind
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, United States.
| | - Katy Murray
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
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34
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Abad CL, Dhaliwal G, Geschwind MD, Saint S, Safdar N. Mass Confusion. J Hosp Med 2017; 12:750-754. [PMID: 28914282 PMCID: PMC7641494 DOI: 10.12788/jhm.2805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Cybele L Abad
- Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Gurpreet Dhaliwal
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Medical Service, San Francisco VA Medical Center, San Francisco, California, USA
| | - Michael D Geschwind
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Sanjay Saint
- Department of Veterans Affairs Medicine Service and Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nasia Safdar
- William S. Middleton Memorial Veterans Hospital and Department of Medicine, University of Wisconsin-Madison School of Medicine, Madison, Wisconsin, USA.
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35
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Wang X, Li N, Liu A, Ma L, Shan P, Jiang W, Zhang Q. Three sporadic cases of Creutzfeldt-Jakob disease in China and their clinical analysis. Exp Ther Med 2017; 14:2664-2670. [PMID: 28962210 DOI: 10.3892/etm.2017.4832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/06/2017] [Indexed: 11/05/2022] Open
Abstract
The present study described the characteristics of three cases of Creutzfeldt-Jakob disease (CJD) in China and analyzed their clinical presentations. The clinical information of the three cases was collected and analyzed. Blood and cerebrospinal fluid (CSF) specimens of the patients were collected for detection of the prion protein (PRNP) gene and 14-3-3 protein levels. Dynamic changes of electroencephalograms (EEGs) and brain magnetic resonance images (MRIs) were also observed. All the three cases were sporadic CJD cases. They presented with symptoms including hyposthenia, progressive memory loss, truncal and limb ataxia, dysarthria, lowered vision acuity, bucking, language disorders, myoclonia and akinetic mutism state. One of the three cases was associated with a prolonged duration of >6 years. The EEG of two cases showed slow biphasic waves. The diffusion-weighted MRI sequence revealed abnormal hyperintensity and bilateral ribboning in the cortex. Two patients tested positive for the 14-3-3 protein in the CSF. All patients were of methionine homozygosity at codon 129 in the gene encoding PRNP protein and one patient had a mutation. The CJD cases showed differences in terms of symptoms and disease duration. Subacute onset was common and with attentive nursing and supportive treatments, one of the patients had a prolonged survival time of >6 years.
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Affiliation(s)
- Xingbang Wang
- Department of Neurology, Cadre Clinic, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Na Li
- Department of Dermatology, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250011, P.R. China
| | - Aifen Liu
- Department of Neurology, Cadre Clinic, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Lin Ma
- Department of Neurology, Cadre Clinic, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Peiyan Shan
- Department of Neurology, Cadre Clinic, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Wenjing Jiang
- Department of Neurology, Cadre Clinic, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Qun Zhang
- Department of Neurology, Cadre Clinic, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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Fernández-Fournier M, Perry DC, Tartaglia MC, de May M, Boxer A, Coppola G, Christine CW, Huang EJ, Seeley WW, Miller BL, DeArmond SJ, Grinberg LT, Geschwind MD. Precipitous Deterioration of Motor Function, Cognition, and Behavior. JAMA Neurol 2017; 74:591-596. [PMID: 28264087 DOI: 10.1001/jamaneurol.2016.6159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A 72-year-old woman developed new-onset depression, sustained an unexplained fall, and started walking cautiously. After 1 year, her depression resolved but she developed a dry cough. One year later, she experienced a more rapid decline in her gait with parkinsonism, visual difficulties with restricted vertical gaze, slowed horizontal and vertical saccades, dysphagia, apathy, and progressive cognitive decline, which led to her death 2 years later. The differential diagnosis, neuroimaging, and pathological findings are discussed, as well as their public health implications.
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Affiliation(s)
- Mireya Fernández-Fournier
- Department of Neurology, La Paz University Hospital, Madrid, Spain2Memory and Aging Center, University of California, San Francisco, San Francisco
| | - David C Perry
- Memory and Aging Center, University of California, San Francisco, San Francisco
| | - Maria Carmela Tartaglia
- Memory and Aging Center, University of California, San Francisco, San Francisco3Department of Neurology, Tanz Centre, University of Toronto, Toronto, Canada
| | - Mary de May
- Memory and Aging Center, University of California, San Francisco, San Francisco
| | - Adam Boxer
- Memory and Aging Center, University of California, San Francisco, San Francisco
| | - Giovanni Coppola
- Departments of Psychiatry & Biobehavioral Sciences and Neurology, University of California, Los Angeles
| | - Chadwick W Christine
- Department of Neurology, Division of Movement Disorders, University of California, San Francisco, San Francisco
| | - Eric J Huang
- Department of Pathology, University of California San Francisco and Pathology Service, Veterans Affairs Medical Center, San Francisco
| | - William W Seeley
- Memory and Aging Center, University of California, San Francisco, San Francisco7Department of Pathology, University of California San Francisco, San Francisco
| | - Bruce L Miller
- Memory and Aging Center, University of California, San Francisco, San Francisco
| | - Steven J DeArmond
- Department of Pathology, University of California San Francisco, San Francisco
| | - Lea T Grinberg
- Memory and Aging Center, University of California, San Francisco, San Francisco7Department of Pathology, University of California San Francisco, San Francisco
| | - Michael D Geschwind
- Memory and Aging Center, University of California, San Francisco, San Francisco
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Detection of CSF 14-3-3 Protein in Sporadic Creutzfeldt-Jakob Disease Patients Using a New Automated Capillary Western Assay. Mol Neurobiol 2017; 55:3537-3545. [DOI: 10.1007/s12035-017-0607-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/08/2017] [Indexed: 11/26/2022]
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Morabito FC, Campolo M, Mammone N, Versaci M, Franceschetti S, Tagliavini F, Sofia V, Fatuzzo D, Gambardella A, Labate A, Mumoli L, Tripodi GG, Gasparini S, Cianci V, Sueri C, Ferlazzo E, Aguglia U. Deep Learning Representation from Electroencephalography of Early-Stage Creutzfeldt-Jakob Disease and Features for Differentiation from Rapidly Progressive Dementia. Int J Neural Syst 2016; 27:1650039. [PMID: 27440465 DOI: 10.1142/s0129065716500398] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A novel technique of quantitative EEG for differentiating patients with early-stage Creutzfeldt–Jakob disease (CJD) from other forms of rapidly progressive dementia (RPD) is proposed. The discrimination is based on the extraction of suitable features from the time-frequency representation of the EEG signals through continuous wavelet transform (CWT). An average measure of complexity of the EEG signal obtained by permutation entropy (PE) is also included. The dimensionality of the feature space is reduced through a multilayer processing system based on the recently emerged deep learning (DL) concept. The DL processor includes a stacked auto-encoder, trained by unsupervised learning techniques, and a classifier whose parameters are determined in a supervised way by associating the known category labels to the reduced vector of high-level features generated by the previous processing blocks. The supervised learning step is carried out by using either support vector machines (SVM) or multilayer neural networks (MLP-NN). A subset of EEG from patients suffering from Alzheimer’s Disease (AD) and healthy controls (HC) is considered for differentiating CJD patients. When fine-tuning the parameters of the global processing system by a supervised learning procedure, the proposed system is able to achieve an average accuracy of 89%, an average sensitivity of 92%, and an average specificity of 89% in differentiating CJD from RPD. Similar results are obtained for CJD versus AD and CJD versus HC.
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Affiliation(s)
| | | | - Nadia Mammone
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo c/da Casazza, SS. 113, Messina, Italy
| | | | | | | | - Vito Sofia
- Institute of Neurology, University of Catania, Italy
| | | | | | | | | | | | - Sara Gasparini
- Magna Græcia University, Catanzaro, Italy
- Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Chiara Sueri
- Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Edoardo Ferlazzo
- Magna Græcia University, Catanzaro, Italy
- Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Umberto Aguglia
- Magna Græcia University, Catanzaro, Italy
- Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
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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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Abstract
PURPOSE OF REVIEW This article presents an update on the clinical aspects of human prion disease, including the wide spectrum of their presentations. RECENT FINDINGS Prion diseases, a group of disorders caused by abnormally shaped proteins called prions, occur in sporadic (Jakob-Creutzfeldt disease), genetic (genetic Jakob-Creutzfeldt disease, Gerstmann-Sträussler-Scheinker syndrome, and fatal familial insomnia), and acquired (kuru, variant Jakob-Creutzfeldt disease, and iatrogenic Jakob-Creutzfeldt disease) forms. This article presents updated information on the clinical features and diagnostic methods for human prion diseases. New antemortem potential diagnostic tests based on amplifying prions in order to detect them are showing very high specificity. Understanding of the diversity of possible presentations of human prion diseases continues to evolve, with some genetic forms progressing slowly over decades, beginning with dysautonomia and neuropathy and progressing to a frontal-executive dementia with pathology of combined prionopathy and tauopathy. Unfortunately, to date, all human prion disease clinical trials have failed to show survival benefit. A very rare polymorphism in the prion protein gene recently has been identified that appears to protect against prion disease; this finding, in addition to providing greater understanding of the prionlike mechanisms of neurodegenerative disorders, might lead to potential treatments. SUMMARY Sporadic Jakob-Creutzfeldt disease is the most common form of human prion disease. Genetic prion diseases, resulting from mutations in the prion-related protein gene (PRNP), are classified based on the mutation, clinical phenotype, and neuropathologic features and can be difficult to diagnose because of their varied presentations. Perhaps most relevant to this Continuum issue on neuroinfectious diseases, acquired prion diseases are caused by accidental transmission to humans, but fortunately, they are the least common form and are becoming rarer as awareness of transmission risk has led to implementation of measures to prevent such occurrences.
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de Pedro-Cuesta J, Martínez-Martín P, Rábano A, Ruiz-Tovar M, Alcalde-Cabero E, Calero M. Etiologic Framework for the Study of Neurodegenerative Disorders as Well as Vascular and Metabolic Comorbidities on the Grounds of Shared Epidemiologic and Biologic Features. Front Aging Neurosci 2016; 8:138. [PMID: 27378910 PMCID: PMC4904010 DOI: 10.3389/fnagi.2016.00138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/27/2016] [Indexed: 12/12/2022] Open
Abstract
Background: During the last two decades, protein aggregation at all organismal levels, from viruses to humans, has emerged from a neglected area of protein science to become a central issue in biology and biomedicine. This article constitutes a risk-based review aimed at supporting an etiologic scenario of selected, sporadic, protein-associated, i.e., conformational, neurodegenerative disorders (NDDs), and their vascular- and metabolic-associated ailments. Methods: A rationale is adopted, to incorporate selected clinical data and results from animal-model research, complementing epidemiologic evidences reported in two prior articles. Findings: Theory is formulated assuming an underlying conformational transmission mechanism, mediated either by horizontal transfer of mammalian genes coding for specific aggregation-prone proteins, or by xeno-templating between bacterial and host proteins. We build a few population-based and experimentally-testable hypotheses focusing on: (1) non-disposable surgical instruments for sporadic Creutzfeldt-Jakob disease (sCJD) and other rapid progressive neurodegenerative dementia (sRPNDd), multiple system atrophy (MSA), and motor neuron disease (MND); and (2) specific bacterial infections such as B. pertussis and E. coli for all forms, but particularly for late-life sporadic conformational, NDDs, type 2 diabetes mellitus (T2DM), and atherosclerosis where natural protein fibrils present in such organisms as a result of adaptation to the human host induce prion-like mechanisms. Conclusion: Implications for cohort alignment and experimental animal research are discussed and research lines proposed.
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Affiliation(s)
- Jesús de Pedro-Cuesta
- Department of Applied Epidemiology, National Center for Epidemiology, Carlos III Institute of HealthMadrid, Spain; Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos IIIMadrid, Spain
| | - Pablo Martínez-Martín
- Department of Applied Epidemiology, National Center for Epidemiology, Carlos III Institute of HealthMadrid, Spain; Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos IIIMadrid, Spain
| | - Alberto Rábano
- Alzheimer Disease Research Unit, CIEN Foundation, Queen Sofia Foundation Alzheimer Center Madrid, Spain
| | - María Ruiz-Tovar
- Department of Applied Epidemiology, National Center for Epidemiology, Carlos III Institute of HealthMadrid, Spain; Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos IIIMadrid, Spain
| | - Enrique Alcalde-Cabero
- Department of Applied Epidemiology, National Center for Epidemiology, Carlos III Institute of HealthMadrid, Spain; Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos IIIMadrid, Spain
| | - Miguel Calero
- Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos IIIMadrid, Spain; Alzheimer Disease Research Unit, CIEN Foundation, Queen Sofia Foundation Alzheimer CenterMadrid, Spain; Chronic Disease Programme, Carlos III Institute of Health, MajadahondaMadrid, Spain
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Subramanian S, Mahadevan A, Satishchandra P, Shankar SK. Development of a dot blot assay with antibodies to recombinant "core" 14-3-3 protein: Evaluation of its usefulness in diagnosis of Creutzfeldt-Jakob disease. Ann Indian Acad Neurol 2016; 19:205-10. [PMID: 27293331 PMCID: PMC4888683 DOI: 10.4103/0972-2327.176867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE Definitive diagnosis of Creutzfeldt-Jakob disease (CJD) requires demonstration of infective prion protein (PrP(Sc)) in brain tissues by immunohistochemistry or immunoblot, making antemortem diagnosis of CJD difficult. The World Health Organization (WHO) recommends detection of 14-3-3 protein in cerebrospinal fluid (CSF) in cases of dementia, with clinical correlation, as a useful diagnostic marker for CJD, obviating the need for brain biopsy. This facility is currently available in only a few specialized centers in the West and no commercial kit is available for clinical diagnostic use in India. Hence the objective of this study was to develop an in-house sensitive assay for quantitation of 14-3-3 protein and to evaluate its diagnostic potential to detect 14-3-3 proteins in CSF as a biomarker in suspected cases of CJD. MATERIALS AND METHODS A minigene expressing the "core" 14-3-3 protein was synthesized by overlapping polymerase chain reaction (PCR) and the recombinant protein was produced by employing a bacterial expression system. Polyclonal antibodies raised in rabbit against the purified recombinant protein were used for developing a dot blot assay with avidin-biotin technology for signal amplification and quantitation of 14-3-3 protein in CSF. RESULTS The results in the present study suggest the diagnostic potential of the dot blot method with about 10-fold difference (P< 0.001) in the CSF levels of 14-3-3 protein between the CJD cases (N= 50) and disease controls (N= 70). The receiver operating characteristic (ROC) analysis of the results suggested an optimal cutoff value of 2 ng/mL. CONCLUSIONS We have developed an indigenous, economical, and sensitive dot blot method for the quantitation of 14-3-3 protein in CSF.
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Affiliation(s)
- Sarada Subramanian
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Susarla Krishna Shankar
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Case Studies Illustrating Focal Alzheimer's, Fluent Aphasia, Late-Onset Memory Loss, and Rapid Dementia. Neurol Clin 2016; 34:699-716. [PMID: 27445249 DOI: 10.1016/j.ncl.2016.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Many dementia subtypes have more shared signs and symptoms than defining ones. We review 8 cases with 4 overlapping syndromes and demonstrate how to distinguish the cases. These include focal cortical presentations of Alzheimer's disease (AD; posterior cortical atrophy and corticobasal syndrome [CBS]), fluent aphasia (semantic dementia and logopenic aphasia), late-onset slowly progressive dementia (hippocampal sclerosis and limbic predominant AD) and rapidly progressive dementia (Creutzfeldt-Jakob disease and limbic encephalitis). Recognizing the different syndromes can help the clinician to improve their diagnostic skills, leading to improved patient outcomes by early and accurate diagnosis, prompt treatment, and appropriate counseling and guidance.
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Abstract
Early and accurate diagnosis of Creutzfeldt-Jakob disease (CJD) is a necessary to distinguish this untreatable disease from treatable rapidly progressive dementias, and to prevent iatrogenic transmission. Currently, definitive diagnosis of CJD requires detection of the abnormally folded, CJD-specific form of protease-resistant prion protein (PrP(CJD)) in brain tissue obtained postmortem or via biopsy; therefore, diagnosis of sporadic CJD in clinical practice is often challenging. Supporting investigations, including MRI, EEG and conventional analyses of cerebrospinal fluid (CSF) biomarkers, are helpful in the diagnostic work-up, but do not allow definitive diagnosis. Recently, novel ultrasensitive seeding assays, based on the amplified detection of PrP(CJD), have improved the diagnostic process; for example, real-time quaking-induced conversion (RT-QuIC) is a sensitive method to detect prion-seeding activity in brain homogenate from humans with any subtype of sporadic CJD. RT-QuIC can also be used for in vivo diagnosis of CJD: its diagnostic sensitivity in detecting PrP(CJD) in CSF samples is 96%, and its specificity is 100%. Recently, we provided evidence that RT-QuIC of olfactory mucosa brushings is a 97% sensitive and 100% specific for sporadic CJD. These assays provide a basis for definitive antemortem diagnosis of prion diseases and, in doing so, improve prospects for reducing the risk of prion transmission. Moreover, they can be used to evaluate outcome measures in therapeutic trials for these as yet untreatable infections.
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An unusual stroke-like clinical presentation of Creutzfeldt-Jakob disease: acute vestibular syndrome. Neurologist 2016; 19:96-8. [PMID: 25888195 DOI: 10.1097/nrl.0000000000000019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Vertigo and dizziness are common neurological symptoms in general practice. Most patients have benign peripheral vestibular disorders, but some have dangerous central causes. Recent research has shown that bedside oculomotor examinations accurately discriminate central from peripheral lesions in those with new, acute, continuous vertigo/dizziness with nausea/vomiting, gait unsteadiness, and nystagmus, known as the acute vestibular syndrome. CASE REPORT A 56-year-old man presented to the emergency department with acute vestibular syndrome for 1 week. The patient had no focal neurological symptoms or signs. The presence of direction-fixed, horizontal nystagmus suppressed by visual fixation without vertical ocular misalignment (skew deviation) was consistent with an acute peripheral vestibulopathy, but bilaterally normal vestibuloocular reflexes, confirmed by quantitative horizontal head impulse testing, strongly indicated a central localization. Because of a long delay in care, the patient left the emergency department without treatment. He returned 1 week later with progressive gait disturbance, limb ataxia, myoclonus, and new cognitive deficits. His subsequent course included a rapid neurological decline culminating in home hospice placement and death within 1 month. Magnetic resonance imaging revealed restricted diffusion involving the basal ganglia and cerebral cortex. Spinal fluid 14-3-3 protein was elevated. The rapidly progressive clinical course with dementia, ataxia, and myoclonus plus corroborative neuroimaging and spinal fluid findings confirmed a clinicoradiographic diagnosis of Creutzfeldt-Jacob disease. CONCLUSIONS To our knowledge, this is the first report of an initial presentation of Creutzfeldt-Jacob disease closely mimicking vestibular neuritis, expanding the known clinical spectrum of prion disease presentations. Despite the initial absence of neurological signs, the central lesion location was differentiated from a benign peripheral vestibulopathy at the first visit using simple bedside vestibular tests. Familiarity with these tests could help providers prevent initial misdiagnosis of important central disorders in patients presenting vertigo or dizziness.
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Maat P, de Beukelaar JW, Jansen C, Schuur M, van Duijn CM, van Coevorden MH, de Graaff E, Titulaer M, Rozemuller AJ, Sillevis Smitt P. Pathologically confirmed autoimmune encephalitis in suspected Creutzfeldt-Jakob disease. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e178. [PMID: 26601117 PMCID: PMC4645173 DOI: 10.1212/nxi.0000000000000178] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/23/2015] [Indexed: 01/17/2023]
Abstract
Objective: To determine the clinical features and presence in CSF of antineuronal antibodies in patients with pathologically proven autoimmune encephalitis derived from a cohort of patients with suspected Creutzfeldt-Jakob disease (CJD). Methods: The Dutch Surveillance Centre for Prion Diseases performed 384 autopsies on patients with suspected CJD over a 14-year period (1998–2011). Clinical information was collected from treating physicians. Antineuronal antibodies were tested in CSF obtained postmortem by immunohistochemistry on fresh frozen rat brain sections, by Luminex assay for the presence of well-characterized onconeural antibodies, and by cell-based assays for antibodies against NMDAR, GABABR1/2, GABAAR GLUR1/2, LGI1, Caspr2, and DPPX. Results: In 203 patients, a diagnosis of definite CJD was made, while in 181 a variety of other conditions were diagnosed, mainly neurodegenerative. In 22 of these 181, the neuropathologist diagnosed autoimmune encephalitis. One patient was excluded because of lack of clinical information. Inflammatory infiltrates were predominantly perivascular and consisted mainly of T cells. The predominant locations were basal ganglia and thalamus (90%) and temporal lobes and hippocampus (81%). In 6 patients (29%), antineuronal antibodies were detected in postmortem CSF, directed against Hu, NMDAR, GABABR1/2, Caspr2, and an unidentified synaptic antigen in 2. The most frequent symptoms were dementia (90%), gait disturbance (86%), cerebellar signs (67%), and neuropsychiatric symptoms (67%). Immunopathologic and clinical findings did not differ between autoantibody-negative patients and patients with antineuronal antibodies. Conclusions: It is important to consider immune-mediated disorders in the differential diagnosis of rapidly progressive neurologic deficits.
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Affiliation(s)
- Peter Maat
- Departments of Neurology (P.M., J.W.d.B., M.H.v.C., M.T., P.S.S.) and Epidemiology (M.S., C.M.v.D.), Erasmus MC, Rotterdam; Dutch Surveillance Centre for Prion Diseases (C.J., A.J.R.), Department of Pathology, University Medical Center Utrecht; Department of Biology (M.H.v.G., E.d.G.), Division of Cell Biology, Utrecht University; and Department of Neurology (J.W.d.B.), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Janet W de Beukelaar
- Departments of Neurology (P.M., J.W.d.B., M.H.v.C., M.T., P.S.S.) and Epidemiology (M.S., C.M.v.D.), Erasmus MC, Rotterdam; Dutch Surveillance Centre for Prion Diseases (C.J., A.J.R.), Department of Pathology, University Medical Center Utrecht; Department of Biology (M.H.v.G., E.d.G.), Division of Cell Biology, Utrecht University; and Department of Neurology (J.W.d.B.), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Casper Jansen
- Departments of Neurology (P.M., J.W.d.B., M.H.v.C., M.T., P.S.S.) and Epidemiology (M.S., C.M.v.D.), Erasmus MC, Rotterdam; Dutch Surveillance Centre for Prion Diseases (C.J., A.J.R.), Department of Pathology, University Medical Center Utrecht; Department of Biology (M.H.v.G., E.d.G.), Division of Cell Biology, Utrecht University; and Department of Neurology (J.W.d.B.), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Maaike Schuur
- Departments of Neurology (P.M., J.W.d.B., M.H.v.C., M.T., P.S.S.) and Epidemiology (M.S., C.M.v.D.), Erasmus MC, Rotterdam; Dutch Surveillance Centre for Prion Diseases (C.J., A.J.R.), Department of Pathology, University Medical Center Utrecht; Department of Biology (M.H.v.G., E.d.G.), Division of Cell Biology, Utrecht University; and Department of Neurology (J.W.d.B.), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Cornelia M van Duijn
- Departments of Neurology (P.M., J.W.d.B., M.H.v.C., M.T., P.S.S.) and Epidemiology (M.S., C.M.v.D.), Erasmus MC, Rotterdam; Dutch Surveillance Centre for Prion Diseases (C.J., A.J.R.), Department of Pathology, University Medical Center Utrecht; Department of Biology (M.H.v.G., E.d.G.), Division of Cell Biology, Utrecht University; and Department of Neurology (J.W.d.B.), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Marleen H van Coevorden
- Departments of Neurology (P.M., J.W.d.B., M.H.v.C., M.T., P.S.S.) and Epidemiology (M.S., C.M.v.D.), Erasmus MC, Rotterdam; Dutch Surveillance Centre for Prion Diseases (C.J., A.J.R.), Department of Pathology, University Medical Center Utrecht; Department of Biology (M.H.v.G., E.d.G.), Division of Cell Biology, Utrecht University; and Department of Neurology (J.W.d.B.), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Esther de Graaff
- Departments of Neurology (P.M., J.W.d.B., M.H.v.C., M.T., P.S.S.) and Epidemiology (M.S., C.M.v.D.), Erasmus MC, Rotterdam; Dutch Surveillance Centre for Prion Diseases (C.J., A.J.R.), Department of Pathology, University Medical Center Utrecht; Department of Biology (M.H.v.G., E.d.G.), Division of Cell Biology, Utrecht University; and Department of Neurology (J.W.d.B.), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Maarten Titulaer
- Departments of Neurology (P.M., J.W.d.B., M.H.v.C., M.T., P.S.S.) and Epidemiology (M.S., C.M.v.D.), Erasmus MC, Rotterdam; Dutch Surveillance Centre for Prion Diseases (C.J., A.J.R.), Department of Pathology, University Medical Center Utrecht; Department of Biology (M.H.v.G., E.d.G.), Division of Cell Biology, Utrecht University; and Department of Neurology (J.W.d.B.), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Annemieke J Rozemuller
- Departments of Neurology (P.M., J.W.d.B., M.H.v.C., M.T., P.S.S.) and Epidemiology (M.S., C.M.v.D.), Erasmus MC, Rotterdam; Dutch Surveillance Centre for Prion Diseases (C.J., A.J.R.), Department of Pathology, University Medical Center Utrecht; Department of Biology (M.H.v.G., E.d.G.), Division of Cell Biology, Utrecht University; and Department of Neurology (J.W.d.B.), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Peter Sillevis Smitt
- Departments of Neurology (P.M., J.W.d.B., M.H.v.C., M.T., P.S.S.) and Epidemiology (M.S., C.M.v.D.), Erasmus MC, Rotterdam; Dutch Surveillance Centre for Prion Diseases (C.J., A.J.R.), Department of Pathology, University Medical Center Utrecht; Department of Biology (M.H.v.G., E.d.G.), Division of Cell Biology, Utrecht University; and Department of Neurology (J.W.d.B.), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
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Ong CJ, Al-Lozi M, Cimino PJ, Bucelli R. Peripheral nervous system hyperexcitability in VV2 sporadic Creutzfeldt-Jakob disease. Neurol Clin Pract 2015; 5:326-332. [PMID: 29443232 DOI: 10.1212/cpj.0000000000000160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Creutzfeldt-Jakob disease (CJD) is a fatal, rapidly progressive neurodegenerative disease. Most cases are sporadic (sCJD). The pathogenesis of sCJD is associated with a conformational change in abnormal prion protein causing widespread neuronal degeneration, and clinical manifestations can be quite protean. Peripheral nerve hyperexcitability syndrome (PNHS) is rarely associated with CJD and is more commonly associated with autoimmune/paraneoplastic syndromes associated with antibodies against the voltage-gated potassium channel complex (VGKC-Abs). Reports of PNHS in CJD are rare. We report 2 patients with progressive cognitive decline in the setting of peripheral nerve hyperexcitability on electrodiagnostic testing. In both patients VGKC-Abs were negative, and autopsy confirmed that both had sCJD, VV2 subtype. While uncommon, it is important to consider sCJD in patients presenting with PNHS and rapidly progressive dementia.
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Affiliation(s)
- Charlene J Ong
- Departments of Neurology (CJO, MA-L, RB) and Pathology (PJC), Washington University in St. Louis, St. Louis, MO
| | - Muhammad Al-Lozi
- Departments of Neurology (CJO, MA-L, RB) and Pathology (PJC), Washington University in St. Louis, St. Louis, MO
| | - Patrick J Cimino
- Departments of Neurology (CJO, MA-L, RB) and Pathology (PJC), Washington University in St. Louis, St. Louis, MO
| | - Robert Bucelli
- Departments of Neurology (CJO, MA-L, RB) and Pathology (PJC), Washington University in St. Louis, St. Louis, MO
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Abstract
Rapidly progressive dementia (RPD) is roughly defined as neurocognitive decline resulting in dementia or death within 2 years. Although RPDs affect all age groups, many occur in patients with young-onset dementia. Although prion disease (eg, Creutzfeldt-Jakob disease) is often thought to be the prototypic rapidly progressive young-onset dementia, the differential diagnosis is broad and some etiologies may be treatable. Hence, an appropriate workup to determine the etiology of RPD is crucial to planning the appropriate management. This article reviews the differential diagnosis, diagnostic workup, and management considerations for this unique patient population.
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Affiliation(s)
- Rajeet Shrestha
- Department of Neurology, Case Western Reserve University School of Medicine & University Hospitals, 3619 Park East Drive, Suite 211, Beachwood, OH 44122, USA; Department of Psychiatry, Case Western Reserve University School of Medicine & University Hospitals, 3619 Park East Drive, Suite 211, Beachwood, OH 44122, USA
| | - Timothy Wuerz
- Department of Neurology, Case Western Reserve University School of Medicine & University Hospitals, 3619 Park East Drive, Suite 211, Beachwood, OH 44122, USA
| | - Brian S Appleby
- Department of Neurology, Case Western Reserve University School of Medicine & University Hospitals, 3619 Park East Drive, Suite 211, Beachwood, OH 44122, USA; Department of Psychiatry, Case Western Reserve University School of Medicine & University Hospitals, 3619 Park East Drive, Suite 211, Beachwood, OH 44122, USA; Department of Pathology, Case Western Reserve University School of Medicine & University Hospitals, 3619 Park East Drive, Suite 211, Beachwood, OH 44122, USA.
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49
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Clinical and neuroimaging characteristics of 14 patients with prionopathy: a descriptive study. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2013.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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50
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Ortega-Cubero S, Pagola I, Luquin MR, Viteri C, Pastor P, Gállego Pérez-Larraya J, de Castro P, Domínguez I, Irimia P, Martínez-Vila E, Arbizu J, Riverol M. Descripción de una serie de pacientes con diagnóstico de enfermedad priónica. Neurologia 2015; 30:144-52. [PMID: 24581735 DOI: 10.1016/j.nrl.2013.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 11/04/2013] [Accepted: 12/11/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- S Ortega-Cubero
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, Navarra, España; Laboratorio de Neurogenética, Neurociencias, Centro de Investigación Médica Aplicada, Universidad de Navarra, Pamplona, Navarra, España.
| | - I Pagola
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - M R Luquin
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - C Viteri
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - P Pastor
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, Navarra, España; Laboratorio de Neurogenética, Neurociencias, Centro de Investigación Médica Aplicada, Universidad de Navarra, Pamplona, Navarra, España
| | | | - P de Castro
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - I Domínguez
- Laboratorio de Neurogenética, Neurociencias, Centro de Investigación Médica Aplicada, Universidad de Navarra, Pamplona, Navarra, España
| | - P Irimia
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - E Martínez-Vila
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - J Arbizu
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - M Riverol
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, Navarra, España
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