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 Creutzfeldt-Jakob disease (sCJD) (Figure 1).
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