Creutzfeldt-Jakob disease with Alzheimer pathology, presenting with status epilepticus following repeated partial seizures: a case report and literature review.

BACKGROUND: Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disease. Common first symptoms are dementia, cerebellar ataxia, visual disturbance, and psychiatric symptoms. Seizure as the first symptom of CJD is a very rare finding. CASE PRESENTATION: We experienced an elderly woman who presented initially with status epilepticus following repeated partial seizures in the course of Alzheimer disease (AD) dementia. Anti-convulsive therapy had no effect. Autopsy revealed definite CJD with AD pathology. COCLUSIONS: This is the first reported CJD case presenting with status epilepticus in the course of AD dementia.

Restless Genital Syndrome Induced by Milnacipran.

OBJECTIVES: Restless genital syndrome (RGS) includes discomfort, pain, numbness, vibration, restlessness, or a burning sensation involving the vagina, perineum, pelvis, penis, and proximal portion of the lower limbs in patients. The RGS has been sometimes reported in Parkinson disease. In patients without Parkinson disease, RGS is also known as persistent genital arousal disorder (PSAS), which includes uncontrollable genital arousal, with or without orgasm or genital engorgement, unrelated to sexual desire. Although withdrawal from selective serotonin reuptake inhibitors antidepressants is reported to induce PSAS, there is no report of RGS or PSAS induced by antidepressants. METHODS: We obtained the consent for the presentation and have not identified individuals for ethical reasons. RESULTS: We first report a woman patient with depression induced RGS by milnacipran (MLN). CONCLUSIONS: We discuss the relationship with restless legs syndrome and the difference from akathisia. It is highly possible MLN affected her RGS because she experienced RGS for the first time after the dose of MLN was increased. A limitation of this report is that we stopped MLN and administered gabapentin enacarbil immediately. We should join MLN to the list of compounds suspected of inducing RGS.

Neurosyphilis Is a Long-forgotten Disease but Still a Possible Etiology for Dementia.

We herein report a heterosexual Japanese man in his forties who had been suffering from advanced dementia and personality change for 4 years. Positive results of a serological test for syphilis, Treponema pallidum hemagglutination assay, and fluorescent treponemal antibody-absorption test of both serum and cerebral spinal fluid led to the diagnosis of neurosyphilis. Jarisch-Herxheimer reaction was seen shortly after the first dose of penicillin was administered to the patient. His cognitive function did not recover after treatment. The incidence of syphilis has been reported to be increasing. Neurosyphilis should not be overlooked as an etiology for progressive dementia even in this post-antibiotic era.

Left frontal lobe hypoperfusion and depressive symptoms in Alzheimer's disease patients taking cholinesterase inhibitors.

Depressive symptoms are common in patients with Alzheimer's disease (AD) and increase the caregiver burden. Many studies have reported dorsolateral prefrontal hypometabolism or hypoperfusion in AD patients with depressive symptoms, most of whom did not take acetylcholinesterase inhibitors (AChEI). It is not clear, however, whether a similar condition is present in patients taking AChEI medication. Fifty-seven consecutive AD patients taking AChEI were recruited at a memory clinic. Objective depressive symptoms were evaluated using the depression domain of the Neuropsychiatric Inventory (NPI-dep). All patients underwent brain single photon emission computed tomography (SPECT) with (99m)Tc-ethylcysteinate dimer, and the SPECT images were analyzed using the Statistical Parametric Mapping 8 program. No significant differences between groups with positive and negative NPI-dep scores were found with respect to age, sex, years of education, and cognitive function. Compared with patients with negative NPI-dep scores, patients with NPI-dep scores ≥1 showed significant hypoperfusion in the left middle frontal region. Our results indicate that the dorsolateral prefrontal area is significantly involved in the pathogenesis of depressive symptoms in AD patients being treated with AChEI. The area on the left side especially may be closely related to the depressive symptoms evaluated using the NPI.