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Dura mater graft‐associated Creutzfeldt‐Jakob disease with 30‐year incubation period
Author(s) -
Shijo Masahiro,
Honda Hiroyuki,
Koyama Sachiko,
Ishitsuka Koji,
Maeda Koichiro,
Kuroda Junya,
Tanii Mitsugu,
Kitazono Takanari,
Iwaki Toru
Publication year - 2017
Publication title -
neuropathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.701
H-Index - 61
eISSN - 1440-1789
pISSN - 0919-6544
DOI - 10.1111/neup.12359
Subject(s) - medicine , dura mater , gliosis , lesion , temporal lobe , occipital lobe , pathology , anatomy , epilepsy , radiology , psychiatry
Over 60% of all patients with dura mater graft‐associated Creutzfeldt‐Jakob disease (dCJD) have been diagnosed in Japan. The incubation period has ranged from 1 to 30 years and the age at onset from 15 to 80 years. Here, we report a 77‐year‐old male Japanese autopsied dCJD case with the longest incubation period so far in Japan. He received a cadaveric dural graft at the right cranial convexity following a craniotomy for meningioma at the age of 46. At 30 years post‐dural graft placement, disorientation was observed as an initial symptom of dCJD. He rapidly began to present with inconsistent speech, cognitive impairment and tremor of the left upper extremity. Occasional myoclonic jerks were predominantly observed on the left side. Brain MRI presented hyperintense signals on diffusion‐weighted and T2‐weighted images, at the right cerebral cortex. The most hyperintense lesion was located at the right parietal lobe, where the dura mater graft had been transplanted. Single‐photon emission CT scan showed markedly decreased cerebral blood flow at the right parietal lobe. EEG revealed diffuse and slow activities with periodic sharp‐wave complex discharges seen in the right parietal, temporal and occipital lobes. He died of pneumonia 9 months after onset. Brain pathology revealed non‐plaque‐type dCJD. Laterality of neuropathological changes, including spongiform change, neuronal loss, gliosis or PrP deposits, was not evident. Western blot analysis showed type 1 PrP CJD . Alzheimer‐type pathology and PSP‐like pathology were also observed.