Epilepsia Partialis Continua as the First Presenting Symptom in Probable Sporadic Creutzfeldt-Jacob Disease: A Case Report and Literature Review

摘要

We present the case of a middle-aged man suffering from epilepsia partialis continua 3 weeks before the start of cognition decline, visual disturbance, and pyramidal dysfunction. The epilepsia partialis continua was difficult to control, and the underlying cause was uncertain even after thorough surveys for infection, inflammation, autoimmunity, and neoplasm. However, progressive signal intensity changes were noted over the involved cortical gyri, bilateral caudate, and putamen on serial magnetic resonance diffusion-weighted images, which were compatible with sporadic Creutzfeldt-Jacob disease. Therefore, we tested for 14-3-3 protein in the cerebrospinal fluid, and the results were positive. Multifocal myoclonus jerks, severe mental decline, akinetic mutism, and typical periodic sharp wave complexes on electroencephalogram developed late in his disease course. He died under the hospice care, and his total disease duration was approximately 5 months. This case highlights that epilepsia partialis continua can be the first presenting symptoms of sporadic Creutzfeldt-Jacob disease, and that magnetic resonance imaging abnormalities can be helpful to identify the disease.