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Early detection of sporadic CJD by diffusion-weighted MRI before the onset of symptoms
  1. Katsuya Satoh1,2,
  2. Ryota Nakaoke1,2,
  3. Yoshihiro Nishiura1,
  4. Akira Tsujino1,
  5. Masakatsu Motomura1,
  6. Toshirou Yoshimura3,
  7. Kensuke Sasaki4,
  8. Kazuto Shigematsu5,
  9. Susumu Shirabe2,
  10. Katsumi Eguchi1
  1. 1The First Department of Internal Medicine, Graduate School of Biomedical Science, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Japan
  2. 2Center for Health and Community Medicine, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Japan
  3. 3Graduate School of Health Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Japan
  4. 4Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan
  5. 5Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  1. Correspondence to Dr Katsuya Satoh, The First Department of Internal Medicine, Graduate School of Biomedical Science, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; f1537{at}cc.nagasaki-u.ac.jp

https://doi.org/10.1136/jnnp.2008.155242

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    According to the WHO diagnostic criteria,1 sporadic Creutzfeldt−Jakob disease (sCJD) is diagnosed by characteristic electroencephalographic (EEG) findings, the presence of 14-3-3 protein in the cerebrospinal fluid (CSF) and appropriate clinical symptoms.1

    Recent studies have made progress towards establishing a diagnosis of sCJD from the combination of diffusion-weighed MR images and 14-3-3 protein detected in the CSF; however, the earliest markers of this disease are not known.

    We evaluated a patient with sCJD who exhibited abnormal high-intensity signals on diffusion-weighed MR imaging (DWI) during an incidental medical check-up that included an MRI. Here, we report the chronological changes in clinical and MRI findings beginning 2 months before disease onset to end-stage sCJD.

    Case report

    A 68-year-old male requested neurological and MRI examinations from his local physician in October, 2005, because his sister had previously died from subarachnoid haemorrhage several years earlier. While DWI of the cerebrum demonstrated a predominantly right-sided high signal intensity in the cortex from the temporal to occipital lobes (figure 1), we did not detect any abnormalities on T2-weighted or FLAIR images. His cognitive function (MMSE 30/30) and neurological findings were normal. In November 2005, repeat MRI demonstrated a slight increase in abnormal findings. We tested …

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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval This study was conducted with the approval of the Nagasaki University.

    • Provenance and peer review Not commissioned; not externally peer reviewed.