CNS INFECTIONS-CJD

SUMMARY

QUESTION
1. PRESENTATION: 60yr old alcoholic man with change in mental status, muscle twitching, fibrillation.
2. INX: CTB normal, EEG normal.

ANSWER
Creutzfeldt-Jakob disease (CJD)

EXPLANATION (variant CJD vs sporadic CJD)
- Age at presentation: median 29yrs for VCJD | vs 60yrs in SCJD.
- Survival and late dementia: median 14 months for VCJD | vs 4 for SCJD.
- Psychiatric features are an early sign (anxiety, withdrawal, apathy, agitation, a permanent look of fear in the eyes, depression, personality change, insomnia). Hallucinations and delusions may occur—before akinetic mutism.
- Painful sensory symptoms are commoner (foot pain, hyperaesthesia) in VCJD.
- Normal EEG in VCJD | SCJD has a characteristic spike and wave pattern.
- Mean CSF tau-pT181/tau protein ratio is 10-fold higher in VCJD than in SCJD.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].