Serial brain CT and 123I-IMP SPECT in a case with Creutzfeldt-Jakob disease

Serial brain CT and 123I-IMP SPECT were examined in a case with Creutzfeldt-Jakob disease (CJD). A 61-year-old woman had the onset of progressive dementia and gait disturbance in December 1988. Then, she developed left hemiparesis and dysarthria, and rapidly fell into akinetic mutism within about 2 months. Brain CT, MRI, and CSF findings showed no definite abnormalities. In February 1989, myoclonic movements appeared in several parts of the body and EEG revealed periodic synchronous discharges. Myoclonus was observed most frequently from March to May 1989, and then reduced gradually. She died in June 1990, and the total clinical course was 19 months. Brain atrophy on CT started from about 4 months after the onset, and progressed subacutely. At the end stage of the disease, diffuse brain atrophy including the cerebellum and the brain stem on CT was observed. SPECT revealed decreased perfusion in the cerebral cortex from 5 months after the onset to the end stage, but; perfusion in the cerebellum and the basal ganglia was relatively kept even at the end stage of the disease. The results suggest that SPECT is a useful examination for presumption of the pathological processes in CJD.