MM1+2C sporadic Creutzfeldt-Jakob disease presenting as rapidly progressive nonfluent aphasia.

We report a 77-year-old man, presenting with progressive aphasia as an initial symptom, who developed severe dementia over the course of 20 months. Frontal cortex PrPSc western blot was type 2 and codon 129 was MM; brain neuropathology showed cortical vacuoles with perivacuolar PrP immunostaining characteristic of MM2C. Cerebellum showed focal coarse, patchy staining in different sections of the molecular layer, diffuse fine punctuate and coarse PrP immunopositive deposits in the granule cell layer, and focal synaptic immunostaining in the molecular layer, suggestive of MM1+2C by histotyping. This clinical presentation has not yet been described in an MM1+2C subtype by histotyping.

Gerstmann-Sträussler-Scheinker syndrome with variable phenotype in a new kindred with PRNP-P102L mutation.

Gerstmann-Sträussler-Scheinker syndrome (GSS) is a dominantly inherited disorder belonging to the group of transmissible human spongiform encephalopathies or prion diseases. Several families affected by GSS with patients carrying mutations in the prion protein gene have been described worldwide. We report clinical, genealogical, neuropathology and molecular study results from two members of the first Argentine kindred affected by GSS. Both family members presented a frontotemporal-like syndrome, one with and the other without ataxia, with different lesions on neuropathology. A Pro to Leu point mutation at codon 102 (P102L) of the prion protein gene was detected in one of the subjects studied. The pathogenic basis of phenotypic variability observed in this family remains unclear, but resembles that observed in other P102L GSS patients from the same family.

Magnetic resonance imaging in E200K and V210I mutations of the prion protein gene.

Magnetic resonance imaging (MRI), with diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR), is a useful diagnostic investigation for Creutzfeldt-Jakob disease (CJD). Amendment of the diagnostic criteria for sporadic CJD (sCJD) to include defined MRI alterations has just recently been proposed. We analyzed MRI scans with FLAIR and/or DWI available of 29 patients with the E200K or the V210I mutation, and a control group of 29 sCJD patients to compare the MRI lesion profile and evaluate the applicability of new MRI criteria to genetic CJD patients. FLAIR images of all 29 patients and controls and DWI images of 15 genetic CJD and 13 sCJD were rated by 2 neuroradiologists blinded to diagnosis and genetic testing. In genetic CJD (gCJD) patients, hyperintensities on FLAIR could be found in the putamen in 55% and the caudate nucleus in 66% and on DWI in 33% and 60%, respectively. Lesion profile and frequency of hyperintensities did not differ significantly from the findings in sCJD. New diagnostic MRI criteria yield similar sensitivity for gCJD and sCJD, being 79% and 72%, respectively. MRI provides useful information in E200K and V210I gCJD patients. The alterations strongly resembled those seen in sCJD, once again demonstrating the similarity of the clinical syndrome in patients with these particular mutations.

Creutzfeldt-Jakob disease surveillance in Argentina, 1997-2008.

BACKGROUND: Epidemiological data on Creutzfeldt-Jakob disease (CJD) from Latin America are limited. We present a comprehensive epidemiological survey on CJD patients in Argentina based on systematic surveillance between 1997 and 2008. METHODS: A CJD Surveillance Referral Center (SRC) was established in Argentina in 1997; previously a Neuropathology Referral Center was used from 1983 to 1996. All suspected cases referred to the SRC were classified using established criteria on the basis of information derived from the following: clinical data form, EEG, MRI (both for central review), cerebrospinal fluid (CSF) for protein 14-3-3 Western blot (WB), autopsy or biopsy material for neuropathology, prion protein (PrP) immunohistochemistry and PrP WB, as well as blood for DNA studies (when brain tissue was not available). RESULTS: Of the 517 patients referred to the SRC between 1997 and 2008, 211 (40.8%) had CJD or other transmissible spongiform encephalopathies (TSEs) (definite or probable). Possible cases totaled 14.5%, while cases with no WHO criteria accounted for 16.4%. Non-CJD cases excluded by biopsy/autopsy or during follow-up corresponded to 28.2% of the 517 referrals. Main differential diagnoses included neurodegenerative diseases such as Alzheimer's disease, frontotemporal dementia, vascular, metabolic or viral encephalopathy, and Hashimoto's disease. Five percent of referred patients ultimately recovered. Eighty-three percent of TSE cases were sporadic CJD; 17% were genetic, mainly E200K (15.6%); the remaining 1.4% included an octarepeat insertion and two Gerstmann-Sträussler-Scheinker cases (P102L). Seventy-four of 100 definite cases had frozen tissue available for molecular subtyping (PrP(Sc)/codon 129). CSF protein 14-3-3 WB sensitivity was 72.3% and specificity was 92.1%. Clinical diagnostic criteria for probable CJD when compared to definite diagnosis by neuropathology showed 71.3% sensitivity, 86.2% specificity, 94.4% positive predictive value and 48% negative predictive value. Country incidence increased over time and reached 0.85 cases per million in 2008, with the highest rate detected in the city of Buenos Aires (1.8). Districts with 6% of the total population have never reported suspected cases. CONCLUSION: In spite of an increase in incidence observed over time, the difference between Buenos Aires city, where the incidence is comparable to that of smaller European countries with higher population density, and the incidence observed in the rest of the country suggests underreporting in nonmetropolitan areas, probably due to a lack of access to specialized medical facilities. CSF WB sensitivity results for protein 14-3-3 were probably linked to the fact that testing was not routinely repeated during the course of the disease, when earlier test results had been negative. The spectrum of molecular CJD subtypes observed did not differ from other countries in Europe. No iatrogenic or variant CJD cases were identified. The sensitivity and negative predictive value of clinical diagnostic criteria for probable CJD (which includes EEG and/or CSF protein 14-3-3 levels) may have been resulted from confirmed cases not meeting probable criteria before autopsy, due to a lack of ancillary tests such as EEG and/or CSF 14-3-3 WB, or because negative tests were not repeated during follow-up.

[Creutzfeldt-Jakob encephalopathy with mutation E200K. Report of a "sporadic" case]. / Encefalopatía de Creutzfeldt--Jakob con mutacion E200K. A propósito de un caso reportado como 'esporádico'.

INTRODUCTION: Creutzfeldt Jakob disease (CJD) has the highest incidence of the whole group of transmissible spongiform encephalopathies or prion diseases, which have the unique feature among all pathologies, to be able to appear as infectious/iatrogenic, sporadic or hereditary, being common to all, the deposition of an abnormal prion protein (PrPSc,CJres) in the central nervous system. More than 20 mutations of the gene (PRNP) that encodes the prion protein have been described. We here report a case of CJD(E200K) refered as probable 'sporadic' according to WHO. METHODS: clinical, pathologic, and molecular features of the disease were characterized using EEG, neuropathology, prionprotein (PrP) Western blot and gene (PRNP) analysis. RESULTS: The patient developed visual hallucinations, myoclonus, memory loss, tremor, disbasia and generalized convulsives seizures dying six months after onset. On neuropathologic examination, spongiform changes were observed and PrP immunopositivity detected. Western blot analysis showed the presence of proteinaseK (PK)-resistant PrP (PrPres) with the nonglycosylatedisoform of approximately 21 kd, and DNA restriction fragment length polymorphism (RFLP) analysis showed the E200K mutation. DISCUSSION: The PRNP(E200K) mutation is the most frequent cause of the hereditary-familial CJD (fCJD). Clusters of this variety have been described in Chileans, Slovaks from Orava, Jews Israelies of Libyan origin, and Japanese. There was no available data of affected relatives of the patient which have suggested he was fCJD, but due to his Chilean origin PRNP studies were carried out. In fact the clinical and pathology of this familial form, with remarkable exceptions, resembles sporadic cases but has a greater incidence, in these groups than sporadic in the general population. CONCLUSION: This patient, although clinically reported as probable 'sporadic', after molecular characterization resulted a CJD(E200K) probably belonging to the Chilean cluster.

Encefalopatía de Creutzfeldt - Jakob con mutación E200K: a propósito de un caso reportado como 'esporádico' / Creutzfeldt-Jakob encephalopathy with mutation E2000K: report of a \"Sporadic\" case

La encefalopatía de Creutzfeldt Jakob (ECJ), es la de mayor incidencia dentro del grupo de las encefalopatías espongiformes transmisibles o enfermedades por priones, las que tienen como característica única entre todas las patologías, la de poder presentarse como esporádica, infecciosa/ iatrogénica, o hereditaria.Se han descrito mas de 20 mutaciones del gen (PRNP) que codifica la proteína prion, capaces de generar la ECJ en su forma hereditaria o familiar (fECJ). Se comunica un caso que fue referido como CJ 'esporádico' probable según criterios de la OMS y resultó después del estudio molecular, CJ familiar E200K.

Encefalopatía de Creutzfeldt - Jakob con mutación E200K: a propósito de un caso reportado como esporádico / Creutzfeldt-Jakob encephalopathy with mutation E2000K: report of a "Sporadic" case

La encefalopatía de Creutzfeldt Jakob (ECJ), es la de mayor incidencia dentro del grupo de las encefalopatías espongiformes transmisibles o enfermedades por priones, las que tienen como característica única entre todas las patologías, la de poder presentarse como esporádica, infecciosa/ iatrogénica, o hereditaria.Se han descrito mas de 20 mutaciones del gen (PRNP) que codifica la proteína prion, capaces de generar la ECJ en su forma hereditaria o familiar (fECJ). Se comunica un caso que fue referido como CJ esporádico probable según criterios de la OMS y resultó después del estudio molecular, CJ familiar E200K. (AU)

Encefalopatía de Creutzfeldt--Jakob con mutacion E200K. A propósito de un caso reportado como esporádico. / [Creutzfeldt-Jakob encephalopathy with mutation E200K. Report of a [quot ]sporadic[quot ] case]

INTRODUCTION: Creutzfeldt Jakob disease (CJD) has the highest incidence of the whole group of transmissible spongiform encephalopathies or prion diseases, which have the unique feature among all pathologies, to be able to appear as infectious/iatrogenic, sporadic or hereditary, being common to all, the deposition of an abnormal prion protein (PrPSc,CJres) in the central nervous system. More than 20 mutations of the gene (PRNP) that encodes the prion protein have been described. We here report a case of CJD(E200K) refered as probable sporadic according to WHO. METHODS: clinical, pathologic, and molecular features of the disease were characterized using EEG, neuropathology, prionprotein (PrP) Western blot and gene (PRNP) analysis. RESULTS: The patient developed visual hallucinations, myoclonus, memory loss, tremor, disbasia and generalized convulsives seizures dying six months after onset. On neuropathologic examination, spongiform changes were observed and PrP immunopositivity detected. Western blot analysis showed the presence of proteinaseK (PK)-resistant PrP (PrPres) with the nonglycosylatedisoform of approximately 21 kd, and DNA restriction fragment length polymorphism (RFLP) analysis showed the E200K mutation. DISCUSSION: The PRNP(E200K) mutation is the most frequent cause of the hereditary-familial CJD (fCJD). Clusters of this variety have been described in Chileans, Slovaks from Orava, Jews Israelies of Libyan origin, and Japanese. There was no available data of affected relatives of the patient which have suggested he was fCJD, but due to his Chilean origin PRNP studies were carried out. In fact the clinical and pathology of this familial form, with remarkable exceptions, resembles sporadic cases but has a greater incidence, in these groups than sporadic in the general population. CONCLUSION: This patient, although clinically reported as probable sporadic, after molecular characterization resulted a CJD(E200K) probably belonging to the Chilean cluster.