Clinical and MRI evaluation of anxiety as the first symptom of sporadic Creutzfeldt-Jakob disease: A case report

Liu,Weibo; Lu,Yunrong; Zhong,Guodong; Jiang,Biao; Pan,Zhijie

doi:10.3892/etm.2016.3041

Clinical and MRI evaluation of anxiety as the first symptom of sporadic Creutzfeldt-Jakob disease: A case report

Authors:
- Weibo Liu
- Yunrong Lu
- Guodong Zhong
- Biao Jiang
- Zhijie Pan
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Affiliations: Department of Psychiatry, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China, Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China, Department of Radiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China, Department of Respiratory Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
Published online on: February 1, 2016 https://doi.org/10.3892/etm.2016.3041
Pages: 1513-1515

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Abstract

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare, transmissible prion disease of the brain, characterized by prominent neurological symptoms and progressive dementia. Early psychiatric manifestations as an initial or sole symptom of sCJD are relatively rare. The current report describes an elderly female patient with sCJD demonstrating anxiety as an initial symptom. The present patient was initially diagnosed with adjustment disorder and anxiety; however, the rapid deterioration of the patient's cognitive and neurological functioning led to a diagnosis of sCJD. Diffusion-weighted magnetic resonance images of the brain supported a diagnosis of sCJD, and it was posited that the abnormalities of gray matter that were observed within the bilateral cingulate cortex may be the pathophysiological basis of the anxiety associated with this case of sCJD. The patient eventually succumbed to inhalational bronchopneumonia 5 months after anxiety onset. The present case report emphasizes the importance of secondary causes of anxiety symptoms in elderly patients, and indicates that brain DWI is a non‑invasive and useful examination in the early diagnosis of sCJD.

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1	Brown P, Gibbs CJ Jr, Rodgers-Johnson P, Asher DM, Sulima MP, Bacote A, Goldfarb LG and Gajdusek DC: Human spongiform encephalopathy: The National Institutes of Health series of 300 cases of experimentally transmitted disease. Ann Neurol. 35:513–529. 1994. View Article : Google Scholar : PubMed/NCBI
2	Wall CA, Rummans TA, Aksamit AJ, Krahn LE and Pankratz VS: Psychiatric manifestations of Creutzfeldt-Jakob disease: A 25-year analysis. J Neuropsychiatry Clin Neurosci. 17:489–495. 2005. View Article : Google Scholar : PubMed/NCBI
3	World Health Organization (WHO): Global surveillance, diagnosis and therapy of human Transmissible Spongiform Encephalopathies: Report of a WHO consultation. Geneva, Switzerland: 9–11–February;1998.Available from. simpleapps.who.int/iris/bitstream/10665/65516/1/WHO_EMC_ZDI_98.9.pdf
4	Chuang DT, O'Dowd MA, Frieder A, Haut SR and Robbins MS: Delayed diagnosis of sporadic Creutzfeldt-Jakob disease in a patient with schizophrenia. Psychosomatics. 53:392–396. 2012. View Article : Google Scholar : PubMed/NCBI
5	Hamilton M: The assessment of anxiety states by rating. Br J Med Psychol. 32:50–55. 1959. View Article : Google Scholar : PubMed/NCBI
6	Rovner BW and Folstein MF: Mini-mental state exam in clinical practice. Hosp Pract (Off Ed). 22:99–103, 106, 110. 1987.PubMed/NCBI
7	Gong YX: Revision of Wechsler Adult Intelligence Scale in China. Acta Psychologica Sinica. 15:362–369. 1983.
8	Appleby BS, Appleby KK and Rabins PV: Does the presentation of Creutzfeldt-Jakob disease vary by age or presumed etiology?. A meta-analysis of the past 10 years. J Neuropsychiatry Clin Neurosci. 19:428–435. 2007. View Article : Google Scholar : PubMed/NCBI
9	Moellentine CK and Rummans TA: The varied neuropsychiatric presentations of Creutzfeldt-Jakob disease. Psychosomatics. 40:260–263. 1999. View Article : Google Scholar : PubMed/NCBI
10	Rabinovici GD, Wang PN, Levin J, Cook L, Pravdin M, Davis J, DeArmond SJ, Barbaro NM, Martindale J, Miller BL and Geschwind MD: First symptom in sporadic Creutzfeldt-Jakob disease. Neurology. 66:286–287. 2006. View Article : Google Scholar : PubMed/NCBI
11	Jardri R, DiPaola C, Lajugie C, Thomas P and Goeb JL: Depressive disorder with psychotic symptoms as psychiatric presentation of sporadic Creutzfeldt-Jakob disease: A case report. Gen Hosp Psychiatry. 28:452–454. 2006. View Article : Google Scholar : PubMed/NCBI
12	Esch T, Stefano GB, Fricchione GL and Benson H: The role of stress in neurodegenerative diseases and mental disorders. Neuro Endocrinol Lett. 23:199–208. 2002.PubMed/NCBI
13	Tartaro A, Fulgente T, Delli Pizzi C, Bonomo L, Bocola V and Onofrj M: MRI alterations as an early finding in Creutzfeld-Jakob disease. Eur J Radiol. 17:155–158. 1993. View Article : Google Scholar : PubMed/NCBI
14	Collins SJ, Sanchez-Juan P, Masters CL, Klug GM, van Duijn C, Poleggi A, Pocchiari M, Almonti S, Cuadrado-Corrales N, de Pedro-Cuesta J, et al: Determinants of diagnostic investigation sensitivities across the clinical spectrum of sporadic Creutzfeldt-Jakob disease. Brain. 129:2278–2287. 2006. View Article : Google Scholar : PubMed/NCBI
15	Geschwind MD: Rapidly progressive dementia: Prion diseases and other rapid dementias. Continuum (Minneap Minn). 16:31–56. 2010.PubMed/NCBI
16	Young GS, Geschwind MD, Fischbein NJ, Martindale JL, Henry RG, Liu S, Lu Y, Wong S, Liu H, Miller BL and Dillon WP: Diffusion-weighted and fluid-attenuated inversion recovery imaging in Creutzfeldt-Jakob disease: High sensitivity and specificity for diagnosis. AJNR Am J Neuroradiol. 26:1551–1562. 2005.PubMed/NCBI
17	Zerr I, Kallenberg K, Summers DM, Romero C, Taratuto A, Heinemann U, Breithaupt M, Varges D, Meissner B, Ladogana A, et al: Updated clinical diagnostic criteria for sporadic Creutzfeldt-Jakob disease. Brain. 132:2659–2668. 2009. View Article : Google Scholar : PubMed/NCBI
18	Bahn MM and Parchi P: Abnormal diffusion-weighted magnetic resonance images in Creutzfeldt-Jakob disease. Arch Neurol. 56:577–583. 1999. View Article : Google Scholar : PubMed/NCBI
19	Yaguchi M, Yaguchi H and Kanaya T: Early lesion of Creutzfeldt-Jakob disease detected by standardizing diffusion-weighted images. Intern Med. 48:1717–1718. 2009. View Article : Google Scholar : PubMed/NCBI
20	Davidson RJ: Anxiety and affective style: Role of prefrontal cortex and amygdala. Biol Psychiatry. 51:68–80. 2002. View Article : Google Scholar : PubMed/NCBI
21	Bystritsky A, Pontillo D, Powers M, Sabb FW, Craske MG and Bookheimer SY: Functional MRI changes during panic anticipation and imagery exposure. Neuroreport. 12:3953–3957. 2001. View Article : Google Scholar : PubMed/NCBI