Autopsy case of MV2K‐type sporadic Creutzfeldt‐Jakob disease with spongiform changes of the cerebral cortex

摘要

Comprehensive analysis is required for the accurate diagnosis of MV2‐type sporadic Creutzfeldt–Jakob disease (sCJD) because it shows a wide clinicopathological spectrum. Here, we describe the clinical findings and neuropathologic observations of an autopsy‐confirmed MV2K‐type sCJD case with extensive spongiform changes of the cerebral cortex. In the early disease stages, the patient exhibited gait disturbance with ataxia and gradually showed cognitive dysfunction. Diffusion‐weighted magnetic resonance images revealed hyperintense regions in the cerebral cortex, basal ganglia, and particularly in the thalamus. Prion protein (PrP) gene analysis revealed no mutations, and polymorphic codon 129 exhibited methionine and valine heterozygosity. During the course of the disease, a startle reaction was observed, whereas myoclonus was not observed. Electroencephalography showed no periodic sharp wave complexes. The patient died at age 61?years with 13?months total disease duration and did not reach the akinetic mutism state. Pathologic investigation revealed extensive fine vacuole‐type spongiform change in the cerebral cortex, and the appearance of vacuolation tended to be more pronounced in the deeper layers. Numerous kuru plaques were observed in the cerebellum. PrP immunostaining revealed extensive diffuse synaptic‐type PrP deposition in the cerebral cortex, and the finding was prominent in the deeper layer with perineuronal‐type PrP deposition. In the limbic system, basal ganglia, and thalamus, mixed small plaque‐type PrP with synaptic‐type PrP deposition was observed. In the cerebellar cortex, diffuse synaptic‐type PrP depositions were observed with numerous strongly immunopositive plaques. Western blot analysis of examined brain samples revealed mixed type 2 PrP Sc (scrapie type) and intermediate‐type PrP Sc .