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- W2340265514 abstract "Objective: Presentation of a case of sporadic fatal insomnia Background: The antemortem diagnosis of sporadic fatal insomnia, a rare form of sporadic prion disease is difficult. Methods: We describe the presentation, work-up, and diagnosis at autopsy of a case of sporadic fatal insomnia. Results: A 28 year old, otherwise healthy male, presented with diplopia and personality changes, followed 8 months later by cerebellar ataxia. Over the next two years he developed sleep disturbance, chorea, myoclonus, psychosis and cognitive impairment. His work up included 2 spinal taps negative for the presence of 14-3-3, brain MRIs, a whole body PET scan, EEG studies, as well as a brain biopsy 24 months following onset of symptoms. The brain biopsy was evaluated at the National Prion Disease Pathology Surveillance Center. These studies did not yield a diagnosis. The brain PET scan showed bilateral hypometabolism in the thalami. He died 34 months following symptom onset. At autopsy, spongiform changes were found affecting the neocortex, and entorhinal cortex. There was severe neuronal loss and gliosis involving the inferior olive and thalami. Western Blot analysis of fresh frozen brain revealed the presence of abnormal protease resistant prion protein. Targeted sequencing of the PRNP gene, as well as whole exome sequencing revealed no pathogenic mutations. The patient was homozygous for methionine at position 129 of the PRNP gene. Conclusions: A negative brain biopsy, and CSF studies that are negative for prion disease, does not rule out a diagnosis of sporadic fatal insomnia, a form of prion disease. Brain PET studies showing decreased metabolism in bilateral thalami, and homozygosity for methionine at position 129 of the PRNP gene are characteristic features of this form of prion disease. In a young patient with rapidly progressive cerebellar ataxia, and cognitive decline, sporadic fatal insominia should be considered in the differential diagnosis. Disclosure: Dr. Lee has nothing to disclose. Dr. Camelo-Piragua has nothing to disclose. Dr. Cali has nothing to disclose. Dr. Cohen has nothing to disclose. Dr. Shakkottai has nothing to disclose." @default.
- W2340265514 created "2016-06-24" @default.
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- W2340265514 date "2016-04-05" @default.
- W2340265514 modified "2023-09-22" @default.
- W2340265514 title "Difficulties in Making an Antemortem Diagnosis of Sporadic Fatal Insomnia, a Rare Form of Sporadic Prion Disease (P5.389)" @default.
- W2340265514 hasPublicationYear "2016" @default.
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