When is a stroke not a stroke? An unusual mimic presenting to AMU.
BACKGROUND
Creutzfeldt-Jakob disease (CJD) is a rare prion disease classically manifesting with rapidly progressive dementia, abnormal movements and typical electroencephalographic (EEG) changes.


METHODS
A 74 year-old Caucasian man was recently discharged from another centre diagnosed with a stroke. He re-presented to our acute medical unit with worsening symptoms, and stroke remained the working diagnosis. Collateral history revealed a progressive cognitive decline and unilateral myoclonus. Further investigations supported the diagnosis of probable CJD, confirmed by the national CJD surveillance centre.


CONCLUSIONS
Signs and symptoms atypical of stroke should raise the possibility of alternative diagnoses, including prion disease. CJD can present with unilateral symptoms, EEG and MRI changes. Early diagnosis prevents unnecessary investigations and treatments, allowing early palliative care input, where appropriate.
Foundation Doctor, Croydon University Hospital, Croydon, Surrey, UK.
Shyamal
S
Patel
ST6 Acute Medicine, East Surrey Hospital, Redhill, Surrey, UK.
Nicholas
N
Smallwood
Senior House Officer, East Surrey Hospital, Redhill, Surrey, UK.
Hyacinth-John
HJ
Abu
Consultant Stroke Physician, East Surrey Hospital, Redhill, Surrey, UK.
Youssif
Y
Abousleiman
D000368:Aged; D007562:Creutzfeldt-Jakob Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D018450:Disease Progression; D004569:Electroencephalography / Q000379:methods*; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009483:Neuropsychological Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging