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Wang T, Safadi AL, Lee ECC, Bicher N, Barry B, Sirdar B, Motamedi GK, Osborne B. Clinical Reasoning: A 56-Year-Old Man With Unusual Presentation of Subacute Encephalopathy and Seizure. Neurology 2022; 98:e95-e102. [PMID: 34649880 DOI: 10.1212/wnl.0000000000012951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tian Wang
- From the Department of Neurology (T.W., A.L.S., N.B., B.B., B.S., G.K.M., B.O.) and Department of Radiology (E.C.C.L.), Georgetown University Hospital, Washington, DC.
| | - Amy Li Safadi
- From the Department of Neurology (T.W., A.L.S., N.B., B.B., B.S., G.K.M., B.O.) and Department of Radiology (E.C.C.L.), Georgetown University Hospital, Washington, DC
| | - Earn Chun Christabel Lee
- From the Department of Neurology (T.W., A.L.S., N.B., B.B., B.S., G.K.M., B.O.) and Department of Radiology (E.C.C.L.), Georgetown University Hospital, Washington, DC
| | - Nathan Bicher
- From the Department of Neurology (T.W., A.L.S., N.B., B.B., B.S., G.K.M., B.O.) and Department of Radiology (E.C.C.L.), Georgetown University Hospital, Washington, DC
| | - Brian Barry
- From the Department of Neurology (T.W., A.L.S., N.B., B.B., B.S., G.K.M., B.O.) and Department of Radiology (E.C.C.L.), Georgetown University Hospital, Washington, DC
| | - Bilaal Sirdar
- From the Department of Neurology (T.W., A.L.S., N.B., B.B., B.S., G.K.M., B.O.) and Department of Radiology (E.C.C.L.), Georgetown University Hospital, Washington, DC
| | - Gholam K Motamedi
- From the Department of Neurology (T.W., A.L.S., N.B., B.B., B.S., G.K.M., B.O.) and Department of Radiology (E.C.C.L.), Georgetown University Hospital, Washington, DC
| | - Benjamin Osborne
- From the Department of Neurology (T.W., A.L.S., N.B., B.B., B.S., G.K.M., B.O.) and Department of Radiology (E.C.C.L.), Georgetown University Hospital, Washington, DC
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Onder H. Letter regarding the article entitled: 'Rapidly progressive sporadic CreutzfeldtJakob disease: isolated Heidenhain variant or a combination with PRES?'. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:854. [PMID: 34669822 DOI: 10.1590/0004-282x-anp-2021-0206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/01/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Halil Onder
- Yozgat City Hospital, Neurology Clinic, Yozgat, Turkey
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Figgie MP, Appleby BS. Clinical Use of Improved Diagnostic Testing for Detection of Prion Disease. Viruses 2021; 13:v13050789. [PMID: 33925126 PMCID: PMC8146465 DOI: 10.3390/v13050789] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
Prion diseases are difficult to recognize as many symptoms are shared among other neurologic pathologies and the full spectra of symptoms usually do not appear until late in the disease course. Additionally, many commonly used laboratory markers are non-specific to prion disease. The recent introduction of second-generation real time quaking induced conversion (RT-QuIC) has revolutionized pre-mortem diagnosis of prion disease due to its extremely high sensitivity and specificity. However, RT-QuIC does not provide prognostic data and has decreased diagnostic accuracy in some rarer, atypical prion diseases. The objective of this review is to provide an overview of the current clinical utility of fluid-based biomarkers, neurodiagnostic testing, and brain imaging in the diagnosis of prion disease and to suggest guidelines for their clinical use, with a focus on rarer prion diseases with atypical features. Recent advancements in laboratory-based testing and imaging criteria have shown improved diagnostic accuracy and prognostic potential in prion disease, but because these diagnostic tests are not sensitive in some prion disease subtypes and diagnostic test sensitivities are unknown in the event that CWD transmits to humans, it is important to continue investigations into the clinical utility of various testing modalities.
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Affiliation(s)
- Mark P. Figgie
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Brian S. Appleby
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA;
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH 44106, USA
- Correspondence:
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Radhakrishnan K. Diagnostic Value of Electroencephalogram in Creutzfeldt-Jakob Disease. Ann Indian Acad Neurol 2020; 23:741-742. [PMID: 33688119 PMCID: PMC7900732 DOI: 10.4103/aian.aian_902_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kurupath Radhakrishnan
- Department of Neurosciences, Avitis Institute of Medical Sciences, Nemmara, Palakkad, Kerala, India
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Ascari LM, Rocha SC, Gonçalves PB, Vieira TCRG, Cordeiro Y. Challenges and Advances in Antemortem Diagnosis of Human Transmissible Spongiform Encephalopathies. Front Bioeng Biotechnol 2020; 8:585896. [PMID: 33195151 PMCID: PMC7606880 DOI: 10.3389/fbioe.2020.585896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022] Open
Abstract
Transmissible spongiform encephalopathies (TSEs), also known as prion diseases, arise from the structural conversion of the monomeric, cellular prion protein (PrPC) into its multimeric scrapie form (PrPSc). These pathologies comprise a group of intractable, rapidly evolving neurodegenerative diseases. Currently, a definitive diagnosis of TSE relies on the detection of PrPSc and/or the identification of pathognomonic histological features in brain tissue samples, which are usually obtained postmortem or, in rare cases, by brain biopsy (antemortem). Over the past two decades, several paraclinical tests for antemortem diagnosis have been developed to preclude the need for brain samples. Some of these alternative methods have been validated and can provide a probable diagnosis when combined with clinical evaluation. Paraclinical tests include in vitro cell-free conversion techniques, such as the real-time quaking-induced conversion (RT-QuIC), as well as immunoassays, electroencephalography (EEG), and brain bioimaging methods, such as magnetic resonance imaging (MRI), whose importance has increased over the years. PrPSc is the main biomarker in TSEs, and the RT-QuIC assay stands out for its ability to detect PrPSc in cerebrospinal fluid (CSF), olfactory mucosa, and dermatome skin samples with high sensitivity and specificity. Other biochemical biomarkers are the proteins 14-3-3, tau, neuron-specific enolase (NSE), astroglial protein S100B, α-synuclein, and neurofilament light chain protein (NFL), but they are not specific for TSEs. This paper reviews the techniques employed for definite diagnosis, as well as the clinical and paraclinical methods for possible and probable diagnosis, both those in use currently and those no longer employed. We also discuss current criteria, challenges, and perspectives for TSE diagnosis. An early and accurate diagnosis may allow earlier implementation of strategies to delay or stop disease progression.
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Affiliation(s)
- Lucas M. Ascari
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stephanie C. Rocha
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Priscila B. Gonçalves
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tuane C. R. G. Vieira
- Institute of Medical Biochemistry Leopoldo de Meis, National Institute of Science and Technology for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yraima Cordeiro
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Freund B, Probasco JC, Cervenka MC, Sutter R, Kaplan PW. EEG Differences in Two Clinically Similar Rapid Dementias: Voltage-Gated Potassium Channel Complex-Associated Autoimmune Encephalitis and Creutzfeldt-Jakob Disease. Clin EEG Neurosci 2019; 50:121-128. [PMID: 29788790 DOI: 10.1177/1550059418774686] [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: 11/15/2022]
Abstract
Distinguishing treatable causes for rapidly progressive dementia from those that are incurable is vital. Creutzfeldt-Jakob disease (CJD) and voltage-gated potassium channel complex-associated autoimmune encephalitis (VGKC AE) are 2 such conditions with disparate outcomes and response to treatment. To determine the differences in electroencephalography between CJD and VGKC AE, we performed a retrospective review of medical records and examined clinical data, neuroimaging, and electroencephalographs performed in patients admitted for evaluation for rapidly progressive dementia diagnosed with CJD and VGKC AE at the Johns Hopkins Hospital and Bayview Medical Center between January 1, 2007 and December 31, 2015. More patients in the VGKC AE group had seizures (12/17) than those with CJD (3/14; P = .008). Serum sodium levels were lower in those with VGKC AE (P = .001). Cerebrospinal fluid (CSF) white blood cell count was higher in VGKC AE (P = .008). CSF protein 14-3-3 (P = .018) was more commonly detected in CJD, and tau levels were higher in those with CJD (P < .006). On neuroimaging, diffusion restriction in the cortex (P = .001), caudate (P < .001), and putamen (P = .001) was more frequent in CJD. Periodic sharp wave complexes (P = .001) and generalized suppressed activity (P = .008) were more common on initial EEG in CJD. On serial EEGs, generalized periodic discharges (P = .004), generalized suppressed activity (P=0.008), and periodic sharp wave complexes (P < .001) were detected more in CJD. This study shows that there are a number of differentiating features between CJD and VGKC AE, and electroencephalography can aid in their diagnoses. Performing serial EEGs better delineates these conditions.
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Affiliation(s)
- Brin Freund
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - John C Probasco
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Raoul Sutter
- Department of Neurology and Intensive Care Units, University Hospital Basel, Basel, Switzerland
| | - Peter W Kaplan
- Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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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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Simabukuro MM, Nóbrega PR, Pitombeira M, Cavalcante WCP, Grativvol RS, Pinto LF, Castro LHM, Nitrini R. The importance of recognizing faciobrachial dystonic seizures in rapidly progressive dementias. Dement Neuropsychol 2016; 10:351-357. [PMID: 29213481 PMCID: PMC5619277 DOI: 10.1590/s1980-5764-2016dn1004016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 11/07/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Creutzfeldt-Jakob Disease (CJD) is the prototypical cause of rapidly progressive dementia (RPD). Nonetheless, efforts to exclude reversible causes of RPD that mimic prion disease are imperative. The recent expanding characterization of neurological syndromes associated with antibodies directed against neuronal cell surface or sympathic antigens, namely autoimmune encephalitis is shifting paradigms in neurology. Such antigens are well known proteins and receptors involved in synaptic transmission. Their dysfunction results in neuropsychiatric symptoms, psychosis, seizures, movement disorders and RPD. Faciobrachial dystonic seizure (FBDS) is a novel characterized type of seizure, specific for anti-LGI1 encephalitis. OBJECTIVE In order to improve clinical recognition we report the cases of two Brazilian patients who presented with characteristic FDBS (illustrated by videos) and anti-LGI1 encephalitis. METHODS We have included all patients with FBDS and confirmed anti-LGI1 encephalitis and video records of FDBS in two tertiary Brazilian centers: Department of Neurology of Hospital das Clínicas, Sao Paulo University, Sao Paulo, Brazil and Hospital Geral de Fortaleza, Fortaleza, Brazil between January 1, 2011 and December 31, 2015. RESULTS Both patients presented with clinical features of limbic encephalitis associated with FBDS, hyponatremia and normal CSF. None of them presented with tumor and both showed a good response after immunotherapy. CONCLUSION FBDSs may be confounded with myoclonus and occurs simultaneously with rapid cognitive decline. Unawareness of FDBS may induce to misdiagnosing a treatable cause of RPD as CJD.
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Affiliation(s)
- Mateus Mistieri Simabukuro
- Neurology Division, Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Paulo Ribeiro Nóbrega
- Neurology Division, Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
- Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Milena Pitombeira
- Neurology Division, Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
- Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | | | - Ronnyson Susano Grativvol
- Neurology Division, Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Lécio Figueira Pinto
- Neurology Division, Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | | | - Ricardo Nitrini
- Neurology Division, Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
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Chen Y, Xing XW, Zhang JT, Wang RX, Zhao W, Tan QC, Liu RZ, Wang XQ, Huang XS, Yu SY. Autoimmune encephalitis mimicking sporadic Creutzfeldt-Jakob disease: A retrospective study. J Neuroimmunol 2016; 295-296:1-8. [PMID: 27235341 DOI: 10.1016/j.jneuroim.2016.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 11/29/2022]
Abstract
Autoimmune encephalitis associated with anti-voltage-gated potassium channel antibodies are most likely to be misdiagnosed as sporadic Creutzfeldt-Jakob disease (sCJD). Our goal was to delineate patients who were initially suspected to have CJD but were later found to have AE. We performed a retrospective clinical review of cases of individuals and made a comparison between groups of patients diagnosed with sCJD and AE. Patients who had rapidly progressing dementia and focal neurological impairment, such as aphasia, gait disturbance, visual disturbance, and depression, at onset were diagnosed with sCJD, whereas epilepsy, hyponatremia and dysautonomia were strong hints for AE. Fluoroscope-positron emission tomography (PET) of patients with AE revealed variable metabolism and normative and long-term immunosuppression were less likely to relapse.
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Affiliation(s)
- Yu Chen
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Xiao-Wei Xing
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Jia-Tang Zhang
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Ruo-Xi Wang
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Wei Zhao
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Qing-Che Tan
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Ruo-Zhuo Liu
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Xiang-Qing Wang
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Xu-Sheng Huang
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Sheng-Yuan Yu
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
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