PMC6000879_01
(a) DaTSCAN detected a slight decrease in tracer uptake in the left caudate nucleus, as well as reduced uptake in the putamina (more marked in the left). (b) Brain MRI scan (axial, diffusion-weighted sequences). Above: hyperintensity in left putamen (arrow). Below: disease progression was associated with involvement of the cortex of the left hemisphere and, to a lesser extent, the right temporoparietal cortex (asterisks). Images were taken at a one-month interval.
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fig1
A brain MRI scan revealed increased signal intensity in the left putamen with diffusion restriction, suggesting lacunar infarction (Figure 1). Parkinsonism was studied using 123I-ioflupane SPECT (DaTSCAN), which revealed asymmetrical tracer uptake in the caudate nuclei (decreased uptake in the left caudate nucleus) and a near-complete lack of activity in the putamina, particularly on the left side (Figure 1). An additional brain MRI scan performed a month after the initial scan revealed progression of the lesions, with a patchy, gyriform hyperintensity predominantly affecting the cortex of the left hemisphere and the right temporoparietal cortex, visible in diffusion sequences only (Figure 1).
EEG recording showing typical generalized periodic triphasic sharp-wave complexes (PSWCs) occurring at a rate of 1/s, fulfilling EEG criteria of sCJD (20 days before death).
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An additional EEG performed 2 months after the first EEG revealed disorganised slow background activity, with generalized periodic sharp-wave complexes (PSWCs) at a frequency of 1 Hz (Figure 2).