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Images in Neurology
October 2008

Fluorine 18–Labeled Fluorodeoxyglucose Positron Emission Tomography in Familial Creutzfeldt-Jakob Disease

Arch Neurol. 2008;65(10):1390-1391. doi:10.1001/archneur.65.10.1390

A 52-year-old right-handed woman presented with progressive memory difficulties and fatigue for 6 weeks. Her mother had died at the age of 46 years, after 6 months of progressive cognitive impairment. Clinical examination showed an apathic, depressed patient with cerebellar ataxia, supranuclear upgaze palsy, episodic memory impairment, and semantic paraphasias. Mini Mental State score was 19 of 30. Neuropsychological testing showed loss of spontaneity, poor verbal fluency tests, impaired forward and backward digit span, and anterograde amnesia with both recall and recognition difficulties, together with moderate agraphia and ideomotor apraxia. There were no hallucinations. Brain magnetic resonance imaging showed basal ganglia and cortical hyperintensities on fluid-attenuated inversion recovery and diffusion-weighted imaging (Figure 1A-D). Electroencephalography revealed generalized periodic sharp wave complexes with left predominance (Figure 1E). Cerebrospinal fluid examination showed the presence of protein 14-3-3. Fluorine 18–labeled fluorodeoxyglucose positron emission tomography (FDG-PET) showed a marked hypometabolism in the cerebellum, basal ganglia, thalamus, and left cortical hemisphere (Figure 2). Genetic sequencing of the prion protein gene showed the presence of a heterozygote E200K missense mutation and a methionine/methionine polymorphism at codon 129. A diagnosis of familial Creutzfeldt-Jakob disease was made. Neurological deterioration continued and a state of akinetic mutism developed 1 month after admission in the presence of right-sided myoclonus. The patient died 2 weeks later.

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