Spreading brain lesions in a familial Creutzfeldt-Jakob disease with V180I mutation over 4 years

Abstract

Background: We report a female patient with familial Creutzfeldt-Jakob disease with V180I mutation (fCJD with V180I), who was serially followed up with magnetic resonance imaging (MRI) and electroencephalogram (EEG) for up to four years.

Case presentation: At 6 months after the onset, diffusion-weighted images (DWI) and fluid-attenuated inversion recovery (FLAIR) of brain MRI revealed an increased signal intensity in the bilateral frontal, temporal, and parietal cerebral cortex with left dominancy except for the occipital lobe. However, her follow-up MRI at four years showed the high-signal regions spreading to the occipital cerebral cortex in DWI and FLAIR images, and bilateral frontal cerebral white matter in FLAIR images. EEG showed a progressive and general slow high-voltage rhythm from 7-8 to 3-5 c/s over four years, without evidence of periodic synchronous discharge. These findings correspond to the symptom progression even after akinetic mutism at 18 months.

Conclusion: We suggest that serial MRI and EEG examinations are useful for early diagnosis of fCJD with V180I and for monitoring disease progression.

Figure 1

DWI images of brain MRI in the present case. Increased signal intensity in the bilateral frontal, temporal, and parietal cerebral cortex with left dominancy, except for occipital lobe, was observed on admission with axial imaging (A-D). Note that the high-signal region spread to the occipital cerebral cortex at four years after the onset (E-H).

Figure 2

FLAIR images of brain MRI in the present case. Increased signal intensity was observed on admission (A-D). Note that the high-signal region spread to the occipital cerebral cortex and the frontal white matter at four years after the onset with a marked ventricular dilatation (E-H).

Figure 3

Electroencephalogram (EEG) in the present case. Note that EEG changed from a generalized slow basic rhythm at 7–8 c/s on admission (A) to a general slower high-voltage basic rhythm at 3–5 c/s after four years, but without PSD (B).