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Psychiatric Symptoms as Bases for Differential Diagnosis of Pre-mortem Sporadic Creutzfeldt-Jakob Disease and Anti-N-Methyl D-aspartate Receptor Encephalitis

Author(s): Yujia Luo, Xi Cheng, Yang Jiao, Huibin Wang, Yifan Liang, Weiyu Teng, Chuansheng Zhao

Unexplained psychiatric symptoms can be a prominent feature in early sporadic Creutzfeldt-Jakob disease (sCJD), which is also common in anti-N-Methyl D-aspartate receptor (anti-NMDA-R) encephalitis. Given that the majority of the patients are initially seen by psychiatrists, it is important that all physicians (especially psychiatrists) consider sCJD and anti-NMDA-R encephalitis as possible causes of unexplained acute psychosis, and be able to differentiate sCJD and anti-NMDA-R encephalitis since the latter is treatable. In general, early diagnosis and treatment is believed to improve patient outcomes, and is critical for protecting families, physicians and nursing staffs from prion transmission during the treatment. In this paper, we retrospectively reviewed the medical records of a 58-year-old woman with an 8-month history of dementia associated with progressive psychiatric symptoms. She was diagnosed with probable sCJD based on the Centers for Disease Control and Prevention (CDC) criteria, with initial findings of memory deficit, confusion and hypoemotivity. High signal abnormalities on bilateral lenticular nucleus, caudate nucleus on diffusion-weighted MRI (DWI) and periodic triphasics in electroencephalography (EEG) were detected.

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