Autopsy case of V180I genetic Creutzfeldt-Jakob disease presenting with early disease pathology

Yasushi Iwasaki, Hiroko Kato, Tetsuo Ando, Akio Akagi, Maya Mimuro, Hiroaki Miyahara, Tetsuyuki Kitamoto, Mari Yoshida

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

The patient was a Japanese woman who experienced a decrease in activity and gait disturbance as the initial symptoms at the age of 86, followed by disorientation and memory dysfunction. Magnetic resonance imaging showed extensive cortical regions with hyperintensity in diffusion-weighted images, and these regions showed swelling in T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. The medial occipital cortex and striatum showed no apparent hyperintensity on diffusion-weighted imaging (DWI). Mild myoclonus was detected, and the patient died 10 months after the onset of symptoms; she did not enter the akinetic mutism state. The patient's brain weighed 1050 g, and neuropathological examination showed extensive characteristic various-sized and non-confluent (VaSNoC) vacuoles in the cerebral cortex. These vacuoles were observable macroscopically by loupe on images of hematoxylin and eosin-stained tissue. Gliosis, hypertrophic astrocytosis, and neuron loss were generally mild in character. Prion protein (PrP) immunostaining showed very mild diffuse-synaptic-type PrP deposition in the cerebral gray matter. These clinicopathological findings led us to several conclusions relative to the early disease pathology of V180I genetic Creutzfeldt–Jakob disease: (i) spongiform change was not found in the medial occipital cortex, which corresponds to the results of DWI; (ii) VaSNoC-type spongiform changes, extensively recognized in the cerebral cortex, corresponded to the DWI findings showing continued hyperintensity with higher brightness, and T2-weighted and FLAIR images findings showing a swelling; and (iii) spongiform changes first appear in the deeper layer and subsequently in the superficial layer in the cerebral cortex.

Original languageEnglish
Pages (from-to)638-645
Number of pages8
JournalNeuropathology
Volume38
Issue number6
DOIs
Publication statusPublished - 2018 Dec
Externally publishedYes

Keywords

  • Creutzfeldt–Jakob disease
  • codon 180
  • diffusion-weighted image
  • spongiform change
  • various-sized and non-confluent vacuole

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Clinical Neurology

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