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Gosden GP, Okromelidze L, Sandhu SJS, Middlebrooks EH. Creutzfeldt–Jakob Disease: An Unusual Presentation of Corticobasal Syndrome. Cureus 2020; 12:e11393. [PMID: 33312792 PMCID: PMC7725196 DOI: 10.7759/cureus.11393] [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] [Indexed: 11/24/2022] Open
Abstract
Corticobasal syndrome is an atypical parkinsonian syndrome consisting of a constellation of clinical findings that can be the result of various etiologies. While most cases are a result of a tauopathy, such as corticobasal degeneration, other etiologies must be considered in the evaluation of patients presenting with corticobasal syndrome. We present a case of a patient presenting with clinical features of corticobasal syndrome due to a prion disease, Creutzfeldt-Jakob disease (CJD), who was initially misdiagnosed due to known pitfalls in the CJD diagnostic criteria. We further discuss this unusual manifestation of CJD presenting as corticobasal syndrome and relevant diagnostic consideration in the evaluation of this entity.
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Annus Á, Csáti A, Vécsei L. Prion diseases: New considerations. Clin Neurol Neurosurg 2016; 150:125-132. [PMID: 27656779 DOI: 10.1016/j.clineuro.2016.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/30/2016] [Accepted: 09/11/2016] [Indexed: 12/30/2022]
Abstract
The transmissible spongiform encephalopathies, which include Creutzfeldt-Jakob disease, are fatal neurodegenerative disorders caused by the pathological accumulation of abnormal prion protein. The diagnosis of Creutzfeldt-Jakob disease is complex. The electroencephalogram, magnetic resonance imaging, lumbar puncture and genetic testing findings can help in the differential diagnosis of rapidly progressive dementia. There has recently been considerable debate as to whether proteins involved in the development of neurodegenerative diseases should be regarded as prions or only share prion-like mechanisms. Two recent reports described the detection of abnormal prion protein in the nasal mucosa and urine of patients with Creutzfeldt-Jakob disease. These findings raise major health concerns regarding the transmissibility of human prion diseases. We set out to address this neurological hot topic and to draw conclusions on the basis of what is known in the literature thus far.
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Affiliation(s)
- Ádám Annus
- Department of Neurology, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary.
| | - Anett Csáti
- Department of Neurology, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary.
| | - László Vécsei
- Department of Neurology, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary; MTA-SZTE Neuroscience Research Group, Szeged, Hungary.
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Coulthart MB, Jansen GH, Cashman NR. Interpretation of cerebrospinal fluid protein tests in the diagnosis of sporadic Creutzfeldt-Jakob disease: an evidence-based approach. CMAJ 2014; 186:E333-9. [PMID: 24446456 DOI: 10.1503/cmaj.130720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Michael B Coulthart
- Canadian Creutzfeldt-Jakob Disease Surveillance System (Coulthart, Jansen), Public Health Agency of Canada, Ottawa, Ont.; the Department of Pathology and Laboratory Medicine (Jansen), The Ottawa Hospital - Civic Campus, Ottawa, Ont.; Brain Research Centre (Cashman), University of British Columbia, Vancouver, BC
| | - Gerard H Jansen
- Canadian Creutzfeldt-Jakob Disease Surveillance System (Coulthart, Jansen), Public Health Agency of Canada, Ottawa, Ont.; the Department of Pathology and Laboratory Medicine (Jansen), The Ottawa Hospital - Civic Campus, Ottawa, Ont.; Brain Research Centre (Cashman), University of British Columbia, Vancouver, BC
| | - Neil R Cashman
- Canadian Creutzfeldt-Jakob Disease Surveillance System (Coulthart, Jansen), Public Health Agency of Canada, Ottawa, Ont.; the Department of Pathology and Laboratory Medicine (Jansen), The Ottawa Hospital - Civic Campus, Ottawa, Ont.; Brain Research Centre (Cashman), University of British Columbia, Vancouver, BC
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Coulthart MB, Jansen GH, Olsen E, Godal DL, Connolly T, Choi BCK, Wang Z, Cashman NR. Diagnostic accuracy of cerebrospinal fluid protein markers for sporadic Creutzfeldt-Jakob disease in Canada: a 6-year prospective study. BMC Neurol 2011; 11:133. [PMID: 22032272 PMCID: PMC3216246 DOI: 10.1186/1471-2377-11-133] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 10/27/2011] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To better characterize the value of cerebrospinal fluid (CSF) proteins as diagnostic markers in a clinical population of subacute encephalopathy patients with relatively low prevalence of sporadic Creutzfeldt-Jakob disease (sCJD), we studied the diagnostic accuracies of several such markers (14-3-3, tau and S100B) in 1000 prospectively and sequentially recruited Canadian patients with clinically suspected sCJD. METHODS The study included 127 patients with autopsy-confirmed sCJD (prevalence = 12.7%) and 873 with probable non-CJD diagnoses. Standard statistical measures of diagnostic accuracy were employed, including sensitivity (Se), specificity (Sp), predictive values (PVs), likelihood ratios (LRs), and Receiver Operating Characteristic (ROC) analysis. RESULTS At optimal cutoff thresholds (empirically selected for 14-3-3, assayed by immunoblot; 976 pg/mL for tau and 2.5 ng/mL for S100B, both assayed by ELISA), Se and Sp respectively were 0.88 (95% CI, 0.81-0.93) and 0.72 (0.69-0.75) for 14-3-3; 0.91 (0.84-0.95) and 0.88 (0.85-0.90) for tau; and 0.87 (0.80-0.92) and 0.87 (0.84-0.89) for S100B. The observed differences in Sp between 14-3-3 and either of the other 2 markers were statistically significant. Positive LRs were 3.1 (2.8-3.6) for 14-3-3; 7.4 (6.9-7.8) for tau; and 6.6 (6.1-7.1) for S100B. Negative LRs were 0.16 (0.10-0.26) for 14-3-3; 0.10 (0.06-0.20) for tau; and 0.15 (0.09-0.20) for S100B. Estimates of areas under ROC curves were 0.947 (0.931-0.961) for tau and 0.908 (0.888-0.926) for S100B. Use of interval LRs (iLRs) significantly enhanced accuracy for patient subsets [e.g., 41/120 (34.2%) of tested sCJD patients displayed tau levels > 10,000 pg/mL, with an iLR of 56.4 (22.8-140.0)], as did combining tau and S100B [e.g., for tau > 976 pg/mL and S100B > 2.5 ng/mL, positive LR = 18.0 (12.9-25.0) and negative LR = 0.02 (0.01-0.09)]. CONCLUSIONS CSF 14-3-3, tau and S100B proteins are useful diagnostic markers of sCJD even in a low-prevalence clinical population. CSF tau showed better overall diagnostic accuracy than 14-3-3 or S100B. Reporting of quantitative assay results and combining tau with S100B could enhance case definitions used in diagnosis and surveillance of sCJD.
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Affiliation(s)
- Michael B Coulthart
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg MB R3E 3R2, Canada
| | - Gerard H Jansen
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, 200 Églantine Driveway AL 1910B, Ottawa ON K1A 0K9, Canada
- Department of Pathology and Laboratory Medicine, Eastern Ontario Regional Laboratory, CCW 4240B, The Ottawa Hospital - General Campus, 501 Smyth Rd, Ottawa ON K1H 8L6, Canada
| | - Elina Olsen
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, 200 Églantine Driveway AL 1910B, Ottawa ON K1A 0K9, Canada
| | - Deborah L Godal
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg MB R3E 3R2, Canada
| | - Tim Connolly
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, 200 Églantine Driveway AL 1910B, Ottawa ON K1A 0K9, Canada
| | - Bernard CK Choi
- Chronic Disease Surveillance and Monitoring Division, CCDPC, HPCDPB, Public Health Agency of Canada, Room 622A3, 785 Carling Avenue, PL# 6806A, Ottawa ON K1A 0K9, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, ON, Canada
- Shantou University Medical College, Shantou, China
| | - Zheng Wang
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, 200 Églantine Driveway AL 1910B, Ottawa ON K1A 0K9, Canada
| | - Neil R Cashman
- Brain Research Centre and PrioNet Canada, University of British Columbia, 2011 Wesbrook Mall, Vancouver BC V6T 2B5, Canada
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Abstract
The spinocerebellar ataxias (SCA) are a large group of inherited disorders affecting the cerebellum and its afferent and efferent pathways. Their hallmark symptom is slowly progressive, symmetrical, midline, and appendicular ataxia. Some may also have associated hyperkinetic movements (chorea, dystonia, myoclonus, postural/action tremor, restless legs, rubral tremor, tics), which may aid in differential diagnosis and provide treatable targets to improve performance and quality of life in these progressive, incurable conditions. The typical dominant ataxias with associated hyperkinetic movements are SCA1-3, 6-8, 12, 14, 15, 17, 19-21, and 27. The common recessive ataxias with associated hyperkinetic movements are ataxia telangiectasia and Friedreich's ataxia. Fragile X tremor-ataxia syndrome (FXTAS) and multiple-system atrophy (a sporadic ataxia which is felt to have a genetic substrate) also have hyperkinetic features. A careful work-up should be done in all apparently sporadic cases, to rule out acquired causes of ataxia, some of which can cause hyperkinetic movements in addition to ataxia. Some testing should be done even in individuals with a confirmed genetic cause, as the presence of a secondary factor (nutritional deficiency, thyroid dysfunction) can contribute to the phenotype.
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Affiliation(s)
- Susan L Perlman
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Early detection of periodic sharp wave complexes on EEG by independent component analysis in patients with Creutzfeldt-Jakob disease. J Clin Neurophysiol 2008; 25:25-31. [PMID: 18303557 DOI: 10.1097/wnp.0b013e318163a7d5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is the most common human prion disease. EEG is the method of choice to support the diagnosis of a human prion disease. Periodic sharp wave complexes (PSWCs) on the EEG usually indicate a progressive stage of CJD. However, PSWCs only become obvious at around 8 to 12 weeks after the onset of clinical symptoms, and in a few cases, even later. Independent component analysis (ICA) is a new technique to separate statistically independent components from a mixture of data. This study recruited seven patients who fit the criteria of CJD between 2002 and 2005 and 10 patients with Alzheimer's disease (AD) as control subjects. Using an ICA algorithm, we were able to split typical PSWCs into several independent temporal components in conjunction with spatial maps. The PSWCs were not observed in the initial EEG studies of patients with either AD or CJD. However, the ICA algorithm was able to extract periodic discharges and epileptiform discharges from raw EEG of patients with CJD at as early as 3 to 5 weeks after disease onset. Such discharges otherwise could hardly be discerned by visual inspection. In conclusion, ICA may increase the sensitivity of EEG and facilitate the early diagnosis of CJD.
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Kovacs GG, Budka H. Prion diseases: from protein to cell pathology. THE AMERICAN JOURNAL OF PATHOLOGY 2008; 172:555-65. [PMID: 18245809 DOI: 10.2353/ajpath.2008.070442] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Prion diseases or transmissible spongiform encephalopathies are fatal neurodegenerative conditions in humans and animals that originate spontaneously, genetically or by infection. Conformational change of the normal (cellular) form of prion protein (PrP c) to a pathological, disease-associated form (PrP TSE) is considered central to pathogenesis and formation of the infectious agent or prion. Neuronal damage is central to clinical manifestation of prion diseases but poorly understood. In this review, we analyze the major pathogenetic pathways that lead to tissue pathology in different forms of disease. Neuropathogenesis of prion diseases evolves in complex ways on several front lines, most but not all of which exist also in other neurodegenerative as well as infectious diseases. Whereas intracellular accumulation of PrP forms might significantly impair cell function and lead to cytopathology, mere extracellular deposition of PrP TSE is questionable as a direct cytotoxic factor. Tissue damage may result from several parallel, interacting, or subsequent pathways. Future studies should clarify the trigger(s) and sequence of these processes and whether, and which, one is dominating or decisive.
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Affiliation(s)
- Gabor G Kovacs
- Institute of Neurology, Medical University of Vienna, AKH 4J, Waehringer Guertel 18-20, POB 48, 1097 Vienna, Austria
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Shibao C, Garland EM, Gamboa A, Vnencak-Jones CL, Van Woeltz M, Haines JL, Yu C, Biaggioni I. PRNP M129V homozygosity in multiple system atrophy vs. Parkinson's disease. Clin Auton Res 2008; 18:13-9. [PMID: 18236005 DOI: 10.1007/s10286-007-0447-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 10/19/2007] [Indexed: 11/24/2022]
Abstract
Multiple system atrophy (MSA) is a neurodegenerative disorder of unknown etiology characterized by extrapyramidal, pyramidal, cerebellar, and autonomic dysfunction in any combination. We report a patient with a 4-year history of MSA who developed dementia associated with sporadic Creutzfeldt-Jakob disease (CJD). Our proband was MM homozygous for the M129V polymorphism within the prion protein gene (PRNP), a known risk factor for CJD. We conducted a case-control study to test the hypothesis that homozygosity for the M129V polymorphism of PRNP occurs more frequently in MSA in comparison to Parkinson's disease and healthy volunteers. A total of 63 patients with MSA, 54 age-, race- and gendermatched controls with Parkinson's disease, and 126 matched healthy volunteers were studied. The genotype analysis revealed no significant difference in the codon 129 genotype distribution in MSA as compared to controls. Nonetheless, the frequencies of the MM and VV genotypes were higher in MSA than in Parkinson's disease. Thus, homozygosity, particularly VV homozygosity, at codon 129 of PRNP is associated with MSA compared to a clinically related but pathophysiologically distinct alpha-synucleinopathy. Considering the possibility that the prion protein contributes to the pathogenesis of MSA would require confirmation of these findings in an independent patient population.
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Affiliation(s)
- Cyndya Shibao
- Autonomic Dysfunction Center, Vanderbilt University, Nashville, TN 37232, USA
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