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Costanzo M, Aiello F, Poleggi A, Li Voti P, Fabbrini G, Belvisi D. Progressive supranuclear palsy phenotype as an atypical clinical presentation of Creutzfeldt-Jakob disease: A case report and review of the literature. Clin Park Relat Disord 2024; 10:100247. [PMID: 38486940 PMCID: PMC10937297 DOI: 10.1016/j.prdoa.2024.100247] [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] [Received: 07/20/2023] [Revised: 10/05/2023] [Accepted: 02/26/2024] [Indexed: 03/17/2024] Open
Abstract
Creutzfeldt-Jakob disease (CJD) is a rare, rapidly progressive neurodegenerative disorder, characterized by the accumulation of abnormal prion proteins in the brain. While CJD has some typical clinical features, its presentation can be quite heterogeneous, particularly in the early stages of the disease, posing challenges in diagnosis. Atypical manifestations of CJD can mimic various neurodegenerative disorders, including atypical parkinsonisms. In this case report, we present an 81-year-old man who exhibited an atypical clinical presentation of sporadic CJD, initially resembling progressive supranuclear palsy (PSP). The patient presented with symmetric parkinsonism, postural instability, and ocular motor dysfunction, accompanied by rapid clinical deterioration. Alongside the case report, we also provide a review of the literature on atypical presentations of CJD as PSP, highlighting the importance of recognizing these manifestations in clinical practice.
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Affiliation(s)
- Matteo Costanzo
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Neurological Centre of Latium, Rome, Italy
| | - Flavia Aiello
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Anna Poleggi
- Unit of Clinic, Diagnostics and Therapy of the Central Nervous System Diseases, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | | | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
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Jiang RY, Aradi S. F198S Gerstmann-Sträussler-Scheinker Syndrome With Parkinsonism, Dyskinesia, and Abnormal (I-123)-FP-CIT Single-Photon Emission Computed Tomography: A Case Report. Cureus 2023; 15:e50594. [PMID: 38226101 PMCID: PMC10788703 DOI: 10.7759/cureus.50594] [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] [Received: 10/09/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Gerstmann-Sträussler-Scheinker syndrome (GSS) is an autosomal dominant neurodegenerative disease caused by point mutations in the prion protein gene (PRNP). While variable, the clinical presentation typically encompasses progressive cerebellar ataxia, pyramidal signs, and cognitive impairment. Here, we report a case of F198S-associated GSS manifesting levodopa-responsive parkinsonism, levodopa-induced dyskinesia, and an abnormal (I-123)-FP-CIT single-photon emission computed tomography (DaT-SPECT). A 66-year-old male patient presented with six years of progressive recall and language impairment, with an initial impression of primary progressive aphasia. Over time he developed progressive cerebellar ataxia and akinetic parkinsonism. There was a family history of ataxia in multiple family members. Levodopa was prescribed up to 450 mg per day without benefit. Genetic testing at age 69 revealed a heterozygous F198S mutation in the PRNP gene, with MV heterozygosity at codon 129. At age 70, he developed mild generalized choreiform dyskinesia. Levodopa was discontinued, resulting in the resolution of dyskinesia with a concomitant marked worsening of akinetic parkinsonism. DaT-SPECT demonstrated bilaterally reduced putaminal binding. This case highlights that GSS can resemble atypical parkinsonism both clinically and with DaT-SPECT imaging. Taking a salient family history and other clinical features into consideration, GSS should be added to the differential diagnoses of such patients.
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Affiliation(s)
- Rena Y Jiang
- Neurology, University of South Florida (USF) Health Morsani College of Medicine, Tampa, USA
| | - Stephen Aradi
- Neurology, University of South Florida (USF) Health Morsani College of Medicine, Tampa, USA
- Neurology, Carol & Frank Morsani Center for Advanced Healthcare, Tampa, USA
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Tang S, Dou X, Zhang Y. 18F-FP-CIT PET/CT in a case of probable sporadic Creutzfeldt-Jakob disease with parkinsonism as initial symptom. Prion 2022; 16:91-94. [PMID: 35801711 PMCID: PMC9272837 DOI: 10.1080/19336896.2022.2093078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Creutzfeldt-Jakob disease (CJD) is a low-prevalence, fatal neurodegenerative disease. Parkinsonism as first symptom of CJD is rare. We present a case manifesting difficulty falling asleep as unspecific prodromal symptom and parkinsonism as initial symptom. The patient received positron emission tomography/computed tomography (PET/CT) of dopamine transporter (DAT) using 18 F-FP-CIT. The DAT-scan demonstrated presynaptic dopaminergic deficit in bilateral posterior putamen, which supports the hypothesis of nigrostriatal pathway dysfunction in CJD.
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Affiliation(s)
- Songhan Tang
- Department of Nuclear Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, Zhejiang, China,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xiaofeng Dou
- Department of Nuclear Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, Zhejiang, China,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Ying Zhang
- Department of Nuclear Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, Zhejiang, China,CONTACT Ying Zhang Department of Nuclear Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang310009, China
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Katsikaki G, Dagklis IE, Angelopoulos P, Ntantos D, Prevezianou A, Bostantjopoulou S. Atypical and early symptoms of sporadic Creutzfeldt – Jakob disease: case series and review of the literature. Int J Neurosci 2020; 131:927-938. [DOI: 10.1080/00207454.2020.1759594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Grammatiki Katsikaki
- 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Ioannis E. Dagklis
- 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Petros Angelopoulos
- 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Dimitrios Ntantos
- 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Angeliki Prevezianou
- 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Sevasti Bostantjopoulou
- 3rd Department of Neurology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
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Tomizawa Y, Taniguchi D, Furukawa Y. Genetic Creutzfeldt-Jakob disease mimicking dementia with Lewy bodies: Clinical and radiological findings. J Neurol Sci 2020; 409:116604. [PMID: 31805431 DOI: 10.1016/j.jns.2019.116604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/12/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Yuji Tomizawa
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan; Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Daisuke Taniguchi
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan; Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshiaki Furukawa
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan; Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan.
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Parkinsonism Associated with Pathological 123I-FP-CIT SPECT (DaTSCAN) Results as the Initial Manifestation of Sporadic Creutzfeldt-Jakob Disease. Case Rep Neurol Med 2018; 2018:5157275. [PMID: 29955403 PMCID: PMC6000879 DOI: 10.1155/2018/5157275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/01/2018] [Accepted: 04/29/2018] [Indexed: 11/21/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is a type of progressive, subacute encephalopathy associated with spongiform degeneration of the central nervous system. sCJD includes a broad and heterogeneous spectrum of clinical variants, but extrapyramidal symptoms and signs at disease onset were rarely reported. We describe a case of unilateral parkinsonism associated with pathological 123I-ioflupane SPECT (DaTSCAN) results as the initial manifestation of M129V subtype sCJD patient. To the best of our knowledge, only 2 cases of Creutzfeldt-Jakob disease demonstrating nigrostriatal dopaminergic deficits in vivo using DaTSCAN have been published in the literature.
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Preserved regional cerebral blood flow in the occipital cortices, brainstem, and cerebellum of patients with V180I-129M genetic Creutzfeldt-Jakob disease in serial SPECT studies. J Neurol Sci 2016; 370:145-151. [PMID: 27772745 DOI: 10.1016/j.jns.2016.09.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/13/2016] [Accepted: 09/21/2016] [Indexed: 12/12/2022]
Abstract
Creutzfeldt-Jakob disease (CJD) with a causative point mutation of valine to isoleucine at codon 180 (V180I) is one of the major types of genetic CJD (gCJD) in Japan. V180I gCJD is rarely accompanied by a family history, and its clinical characteristics include late-onset, long disease duration, and edematous cortical hyperintensity in diffusion, fluid attenuate inversion and T2-weighted MRI. We performed serial imaging with single-photon emission computed tomography (SPECT) and MRI in three V180I gCJD cases over long-term observation. All cases were characterized by progressive dementia, parkinsonism, and the absence of cerebellar signs or cortical visual dysfunction in their clinical courses. Moreover, during the end-stage, SPECT findings showed preserved regional cerebral blood flow (rCBF) in the occipital cortices, brainstem, and cerebellum. Similarly, no apparent atrophy or increased signal intensities were observed in MRI images of the occipital and cerebellar regions. In conclusion, we report a decrease in rCBF predominantly in the frontal and temporal cortices during the early-stage, which became more widespread as the disease progressed. Importantly, rCBF was preserved in the occipital cortices, brainstem, and cerebellar regions until the end-stage, which may be distinct to V180I gCJD cases.
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