Successful Early Recognition of CJD in a 62 Y.O. Patient with Rapid Neurological Deterioration

PACE Hospitals’ expert Neurology team successfully managed a 62-year-old male patient diagnosed with  Creutzfeldt–Jakob Disease (CJD). Management aimed to control progressive neurological symptoms such as difficulty in walking, tremors, involuntary jerky movements, and memory disturbances. The treatment also focused on stabilizing the patient and providing supportive neurological care to improve overall comfort and quality of life.

Chief Complaints

A 62-year-old male patient with a body mass index (BMI) of 22.3 presented to the Neurology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of unsteadiness while walking associated with involuntary jerky movements of the entire body and a tendency to fall. The symptoms were of acute onset and had rapidly worsened over a period of one and a half months, along with difficulty in walking, accompanied by tremors and memory disturbances.

The patient had no known prior medical illnesses or comorbidities. There was a history of memory and behavioral disturbances and intermittent episodes of fever for approximately six months prior to admission.

On examination, the patient was conscious, coherent and oriented. His general condition was stable with normal vital signs. Neurological assessment revealed impaired memory and dysarthric (slurred) speech. Muscle tone showed axial and appendicular rigidity, while muscle power was normal. Deep tendon reflexes were intact, and involuntary jerky movements of all four limbs were present and worsened with action or stimulus. Overall, the systemic and neurological examinations were consistent with abnormal neurological findings.

Upon admission, the patient underwent a comprehensive clinical evaluation, along with the patient’s medical history and neurological assessment conducted by the Neurology team.

Laboratory investigations were conducted as part of the assessment. Complete blood count (CBC) and renal and liver function tests were within normal limits. Thyroid function tests (T3, T4, and TSH) were normal. Viral screening for HIV, Hepatitis B, and Hepatitis C was non-reactive. Coagulation profile, including prothrombin time and INR, was within normal range.

Neuroimaging investigations, including Magnetic Resonance Imaging (MRI) of the brain, demonstrated cortical ribboning and hyperintensities in the parieto-temporal lobes. Electroencephalography (EEG) showed delta to theta slowing with asymmetrical periodic sharp wave complexes, suggestive of subacute encephalitis – Creutzfeldt–Jakob Disease (CJD). Cerebrospinal fluid analysis was within normal limits except for a positive 14-3-3 protein. During the hospital stay, the patient was also noted to have acute kidney injury (pre-renal, recovered) and newly diagnosed hypertension (de novo).

Based on the confirmed diagnosis, the patient was advised to undergo Creutzfeldt–Jakob Disease (CJD) Treatment in Hyderabad, India, under the expert care of the Neurology Department with continued monitoring and management of renal function and blood pressure.

After a detailed consultation by Dr. S Pramod Kumar, Consultant Neurophysician, along with cross-consultants Dr. Snigda Panuganti, Dr. Manasa Gaddam, and Dr. Renuka Seshamamba Kanala, the patient was diagnosed with subacute encephalitis suspected to be Creutzfeldt–Jakob Disease (CJD) with progressive neurological symptoms including gait instability, tremors, involuntary jerky movements, and memory disturbances. Since the patient’s symptoms were rapidly progressive and did not respond to initial supportive care alone, comprehensive medical management was identified as the most appropriate treatment.

It was determined that therapy for infection control, anti-inflammatory therapy, control of involuntary movements, neuroprotection, blood pressure management, along with physiotherapy and multidisciplinary monitoring, was identified as the most appropriate plan to stabilize the patient, address acute kidney injury (pre-renal, recovered) and newly diagnosed hypertension (de novo), and optimize overall outcomes.

The patient and his family members were counselled in detail regarding the nature of the disease, expected progression, supportive care requirements, importance of therapy adherence, home care measures, and the need for regular follow-up in the Neurology outpatient department to optimise management and monitor complications.

Following the decision, the patient underwent treatment for Creutzfeldt–Jakob Disease (CJD), acute kidney injury (pre-renal, recovered), and newly diagnosed hypertension (de novo) in Hyderabad at PACE Hospitals, under the expert supervision of the Neurology team.

During his hospital stay, the patient received therapy for controlling infection, reducing inflammation, managing involuntary movements, providing neuroprotection, maintaining blood pressure, supporting bowel function, and improving mobility through physiotherapy, under multidisciplinary monitoring and other supportive measures to stabilize his condition and optimize overall outcomes.

At discharge, the patient was advised to continue medications for controlling involuntary movements, managing anxiety and sleep disturbances, protecting the stomach lining, supporting neuroprotection, controlling blood pressure, and maintaining regular bowel movements. These therapies were prescribed to stabilize his neurological condition, manage comorbidities, and support overall recovery at home.

The patient was prescribed medications as advised. Physiotherapy and frequent position changes in bed were recommended to prevent bedsores, along with proper care of the Foley catheter to reduce the risk of infection.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, sudden worsening of movements, weakness, or any alarming symptoms.

The patient was advised to return for a follow-up with the Neurophysician in Hyderabad at PACE Hospitals after 2 weeks.

This case highlights Creutzfeldt–Jakob Disease (CJD) complicated by acute kidney injury (recovered) and newly diagnosed hypertension. The patient presented with gait instability, involuntary movements, and cognitive disturbances. He was managed with supportive care, neuroprotection, blood pressure control, and physiotherapy, and discharged in stable condition.