Creutzfeldt-Jakob Disease Presenting as Expressive Aphasia and Nonconvulsive Status Epilepticus

Figure 2

MRIs.

(a) Hospital day two: no evidence of acute pathology except mild diffuse cerebral and cerebellar substance loss on MRI

(b) Hospital day five: DW-MRI showing cortical and gyriform diffusion signal hyperintensity with cortical ribbon edema (cytotoxic edema) in the left frontal and parietal lobes, likely due to persistent seizure activity. Punctate calcification in the right frontal cortex is also visible

(c) Hospital day nine: persistent cortical ribboning particularly around the left hemisphere with frontal lobe > parietal lobe. There is also involvement of right frontal cortex

(d) Hospital day twenty-three: extensive and persistent worsening of cortical ribboning particularly around the left hemisphere and involving right frontal and limited involvement of the basal ganglia