Towards an early clinical diagnosis of sporadic CJD VV2 (ataxic type)

Simone Baiardi, Anna Magherini, Sabina Capellari, Veronica Redaelli, Anna Ladogana, Marcello Rossi, Fabrizio Tagliavini, Maurizio Pocchiari, Giorgio Giaccone, Piero Parchi

Research output: Contribution to journalArticle

Abstract

INTRODUCTION:
Sporadic Creutzfeldt-Jakob disease (sCJD) includes a broad spectrum of clinical-pathological subtypes, which complicates the clinical differential diagnosis with other rapidly progressive neurological syndromes.
AIM:
To provide a better characterisation of clinical features and results of diagnostic investigations, especially at an early disease stage, in patients with sCJDVV2, the second most common sCJD subtype.
METHODS:
We evaluated neurological symptoms/signs, and results of brain diffusion-weighted resonance imaging (DW-MRI), electroencephalographic recordings (EEG) and cerebrospinal fluid (CSF) biomarker studies in 120 patients with a definite (n=93) or probable (n=27) diagnosis of sCJDVV2.
RESULTS:
All patients presented with prominent cerebellar signs, which were often associated with memory loss and/or oculomotor, visual or peripheral/spinal cord signs. In contrast, dementia was invariably a late finding. All CSF samples were positive for the 14-3-3 protein assay and had total-tau protein levels above 1250 pg/mL. Brain DW-MRI showed hyperintensity of basal ganglia, thalamus and cerebral cortex, respectively in 91.5%, 57.4% and 19.1% of cases. EEG revealed periodic sharp-wave complexes in only 17.8% of cases.
CONCLUSIONS:
sCJDVV2 should be considered in any patient presenting with a rapidly progressive ataxia, especially when associated with oculomotor, visual or peripheral/spinal cord signs, even in the absence of dementia or myoclonus. CSF assays and brain DW-MRI represent sensitive diagnostic tests, even at an early stage. These data strongly suggest that sCJDVV2 can be clinically diagnosed early and accurately based on clinical data, DW-MRI, CSF assays and codon 129 genotyping and provide the basis for improved and subtype-specific diagnostic criteria of sCJD.
Original languageEnglish
Pages (from-to)764-772
Number of pages9
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume88
Issue number9
Publication statusPublished - 2017

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Keywords

  • Sporadic creutzfeldt-jakob disease
  • PrP typing

Cite this

Baiardi, S., Magherini, A., Capellari, S., Redaelli, V., Ladogana, A., Rossi, M., Tagliavini, F., Pocchiari, M., Giaccone, G., & Parchi, P. (2017). Towards an early clinical diagnosis of sporadic CJD VV2 (ataxic type). Journal of Neurology, Neurosurgery and Psychiatry, 88(9), 764-772.