engleski

Brain perfusion SPECT with 99mTc-HMPAO in diagnosis of rapid mental deterioration – case report of Creutzfeldt – Jakob disease

A 74-year old male was hospitalized in University Hospital Center Sestre Milosrdnice, Department of Neurology after his family noticed unusual behaviour, mood disorders, memory disturbance, inappropriate actions (lightening cigarette with spoon), and unawarenees of his symptoms. The patient has been mostly healthy and never been hospitalised or took any chronic medications. Physical examination was unremarkable, neurological examination showed cognitive decline, bradykinesia, nominal dysphasia and hypomimia. Extended radiological, diagnostics and laboratories methods were performed. Brain MRI with gadolinium showed extensive high intensities with restricted diffusion in the bilateral temporal cortex, dominant left, left frontal cortex, lateral parietal cortex and in the right parietal lobe. Creutzfeldt-Jakob disease or encephalitis was presumed. Brain perfusion SPECT with 99m Tc – HMPAO was performed and characteristic pattern of hypoperfusion for Alzheimer's disease and Levy-body dementia was excluded. Hypoperfusion was dominant in left frontal lobe, left temporal lobe, and in lateral parts of both parietal lobes. Also significant difference in visualisation of nucleus caudatus with right hypoperfusion was seen. Cerebrospinal fluid analysis for autoimmune encephalitis, viruses and bacterial were negative. EEG was abnormal with diffuse cerebral dysfunction. Paraneoplastic etiology of mental decline was excluded. Real-time quaking –induced conversion (RT-QuIC) and 14.3.3. were positive. Progressive dementia, a typical clinical features, MRI and EEG pattern and positive RT-QuIC and 14.3.3. in CSL are the methods of choice for early diagnosis of Creutzfeldt-Jakob disease. Hypoperfusion in brain SPECT with 99mTc HMPAO, in accordance with brain MRI, can help us to exclude other types of dementia.

brain perfusion ; Creutzfeldt-Jacob disease ; mental deterioration

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