We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Images in Neurology |

Diaschisis as the Presenting Feature in Sporadic Creutzfeldt-Jakob Disease

Daryl Wile, MD; Harinder Dhaliwal, MBBS; Justyna R. Sarna, MD, PhD; Christine P. Molnar, MD; James N. Scott, MD; Fiona Costello, MD; Sarah Furtado, MD, PhD; Jeffrey T. Joseph, MD, PhD
JAMA Neurol. 2013;70(3):408-409. doi:10.1001/jamaneurol.2013.590.
Text Size: A A A
Published online


A 71-year-old man presented with 6 weeks of progressive left-hand incoordination, gait unsteadiness, dysarthria, left facial weakness, and left-sided myoclonus. Examination also demonstrated slowed verbal responses, ideomotor apraxia, and hypometric saccades with a wide-based, unsteady gait and rigidity, marked dysmetria, and intention tremor of the left arm and leg.

Magnetic resonance imaging (MRI) of the brain showed diffusion restriction in the right frontal, parietal, occipital, and superior temporal lobes; the left parietal lobe; and the right caudate head. Fludeoxyglucose positron emission tomography (FDG-PET) imaging was undertaken to reconcile the normal MRI appearance of the cerebellum with its prominent clinical dysfunction. Hypometabolism was evident in the areas of cerebral diffusion restriction and in the left cerebellum (Figure 1). Cerebrospinal fluid was positive for 14-3-3 protein, supporting the diagnosis of Creutzfeldt-Jakob disease. The patient progressively deteriorated and died in hospice 1 month after presentation.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Cerebral (A) and cerebellar (C) diffusion-weighted magnetic resonance images; note the right-sided cerebral cortical diffusion restriction (A) with normal appearance of the cerebellum. Fludeoxyglucose positron emission tomography hypometabolism corresponds to areas of cerebral cortical diffusion restriction (B) but is also evident in the left cerebellum (D).

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. The right cerebral hemisphere (A and D) shows spongiform change corresponding to cerebral diffusion restriction and hypometabolism. There is minimal spongiform change in the left hemisphere (B and E) and bilaterally in the cerebellum (C, F, and G). A-C, Hematoxylin-eosin with the green RGB channel digitally isolated and inverted to show spongiform change as black dots. D-G, Areas marked by white arrows in A-C (hematoxylin-eosin, original magnification ×4). D and E, inset views, hematoxylin-eosin (original magnification ×20). The left hemisphere did show some spongiform change (black arrow, B).




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles