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Altered Basal Ganglia Echogenicity Early in Sporadic Creutzfeldt-Jakob Disease

Veselinovic, Nikola MD*; Pavlovic, Aleksandra M. MD, PhD*; Petrovic, Boris MD; Ristic, Aleksandar MD, PhD*; Novakovic, Ivana MD, PhD*; Svabic Medjedovic, Tamara MD*; Pavlovic, Dragan MD, PhD; Sternic, Nada MD, PhD*

Cognitive & Behavioral Neurology:
doi: 10.1097/WNN.0000000000000015
Case Reports
Abstract

Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disease caused by conformational alteration of the ubiquitous prion protein. Sporadic CJD appears to progress faster if the basal ganglia are shown to be affected on magnetic resonance imaging. Transcranial B-mode sonography (TCS) enables visualization of differences in tissue echogenicity, which can be associated with changes in the cerebral metabolism of various metals. These metabolic changes are considered 1 of the potential mechanisms of the brain damage in CJD; TCS hyperechogenicity may reflect changes in metal homeostasis in CJD. We report a 63-year-old woman who presented with typical sporadic CJD. One month after she fell ill, a magnetic resonance imaging scan of her brain showed diffuse cortical but no obvious basal ganglia involvement. However, TCS revealed moderate hyperechogenicity of both lentiform nuclei. The patient’s disease progressed quickly and she died 2 months later. TCS may show basal ganglia alteration early in the disease course of patients with quickly progressing CJD, thus aiding in premortem diagnosis.

Author Information

*Clinic for Neurology, Faculty of Medicine

Faculty for Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia

Diagnostic Center VAMED-VMR, Novi Sad, Serbia

N.V. and A.M.P. share first authorship for the article.

Supported in part by the Ministry of Education, Science and Technological Development of the Republic of Serbia: Scientific Projects No. 175022, 175033, and 175091.

The authors report no conflicts of interest.

Reprints: Aleksandra M. Pavlovic, MD, PhD, Faculty of Medicine, University of Belgrade, Clinic for Neurology, Clinical Center of Serbia, Dr Subotića 6, 11000 Belgrade, Serbia (e-mail: aleksandrapavlovic@hotmail.com).

Received October 16, 2012

Accepted April 15, 2013

© 2014 by Lippincott Williams & Wilkins.