Presentation
Progressive cognitive decline with personality changes, speech and motor impairment and jerky movements in the upper limbs.
Patient Data
Asymmetrical bilateral distribution of gyriform restricted diffusion at the left frontal, bi-parietal, and left occipital lobes.
No restricted diffusion in the basal ganglia, thalami and brain stem. The post contrast images show no abnormal enhancement of the parenchymal, meningeal, or cranial nerves. Patent dural venous sinuses and cortical veins.
No evidence of space occupying lesion or hemorrhage. No evidence of territorial infarction. Normal ventricular system and central midline structures. Clear cerebello-pontine angles cisterns. No lesions in posterior fossa. No epidural or subdural collection.
Case Discussion
The history and MRI findings of gyriform restricted diffusions (cortical ribbon sign) favor Creutzfeldt-Jakob disease.
No definite involvement of the basal ganglia and thalami could be seen in this brain MRI.
Case courtesy of Dr. Mousa Sayej, consultant neuroradiologist.