Age and Ageing 2013; 42: 660–661
© The Author 2013. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email:
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Clinical Reminder A rare presentation to TIA clinic A 76-year-old lady was referred to the rapid access TIA clinic, with a 4-week history of unsteadiness without cognitive decline. On examination she was found to have marked bilateral cerebellar signs. CT head showed extensive small vessel disease. The clinical presentation was deemed disproportionate to the CT, and she was referred for an outpatient MRI brain scan. Four days later she presented to the acute medical take with rapid deterioration. She was mute and only able to climb stairs on all fours. An urgent MRI and EEG were arranged, confirming the suspected diagnosis of sporadic CreutzfeldtJakob disease (sCJD) (Figure 1).
A recent study suggested 5% of sCJD cases present with cerebellar signs [2]. Owing to the rapid decline, it is imperative that the signs are recognised early to avoid unnecessary, costly investigations, to inform family members and to enable participation in end-of-life decisions. Furthermore, early identification facilitates analysis by the National CJD Surveillance Unit. LAUREN MCCLUSKEY1, BENJAMIN SOUKUP2, JULIE DOVEY2,* Care of the Elderly, Bristol Royal Infirmary, Malbourgh Street, Bristol BS2 8HW, UK 2 Geriatric Medicine, Bristol Royal Infirmary, Avon, Bristol, UK Fax: 01173423915 Email:
[email protected] *To whom correspondence should be addressed
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Figure 1. The EEG showed the classic wave formation for sporadic Creutzfeldt-Jakob disease, periodic complexes at 1 per second with a low amplitude featureless background (see [1]).
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Clinical Reminder
References 1. Smith SJM. EEG in neurological conditions other than epilepsy: when does it help, what does it add. J Neurol Neurosurg Psychiatry 2005; 76: ii8–ii12.
2. Cooper SA, Murray KL, Heath CA, Will RG, Knight RS. Sporadic Creutzfeldt-Jakob disease with cerebellar ataxia at onset in the UK. J Neurol Neurosurg Psychiatry 2006; 77: 1273–5. doi: 10.1093/ageing/aft092
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