

Medical Mystery Monday #130: the case of the clumsiness


Happy Monday! Today you get to be the medical student and diagnose our patient. What do you think is the underlying cause of all of her symptoms?

A 55 year old woman is referred to a neurologist because she has been unusually clumsy lately. She states that over the past several months, she has been dropping items, nearly falling, and bumping into things, which she never used to do. She also admits to not being as mentally sharp as she usually is, and is finding it difficult to keep up at her job. The patient’s daughter is accompanying her, and adds that the patient doesn’t quite seem like herself lately, showing little emotion. The patient admits to being diagnosed with depression about four months ago, with insomnia, irritability, anxiety, and loss of interest in activities. Her depression has improved slightly with an anti-depressant medication (SSRI). The patient adds that she has noted occasional “jerking” of her arms, similar to the jerking movement of the limbs when one is falling asleep. The patient has no medical history other than her recent depression.

The first thing the physician notices is slurred speech, which the daughter confirms is not how the patient used to talk. On cognitive testing, the patient can state her name, that she is in the doctor’s office (though cannot name the address), and states that it is April 21st. She has trouble recalling the name of the vice president. When asked to perform mental math questions, she has difficulty, becomes frustrated, and refuses to continue with that line of questioning. The patient’s neurologic exam was notable for impaired balance when she walks, and increased reflexes. The remainder of the neurologic and general physical exam is normal. The neurologist sends her for an MRI of the brain, which is shown below. A brain biopsy of a similar patient is also shown below.

What is the most likely diagnosis?

MRI of the patient's brain. From Collie DA et al. Am J Neuroradiol, 2003;24: 1560-9.

MRI of the patient’s brain. From Collie DA et al. Am J Neuroradiol, 2003;24: 1560-9.

A similar patient's brain biopsy. From Cohen D et al. Epilepsy & Behavior; 2004 5(5): pp.792–796.


Marianne DiNapoli

16 Responses

  1. Rich S says:

    variant Creutzfeldt-Jakob disease

  2. F says:

    Creutzfeldt–Jakob disease?

  3. Stefan says:


  4. Maureen says:

    It could be lyme disease, a stroke or MS. Not sure how to tell the difference in a MRI.

  5. PC says:

    Biopsy looks spongy…CJD? Ate a British hamburger?

  6. Danny Noonan says:

    Just a guess because my mother in law had it and her sounds like her symptoms in the early stages. Multiple Sclerosis?

  7. kathy G says:

    Is it multiple sclerosis?

  8. JJ says:


  9. JJ says:

    Mad Cow Disease?

  10. NG says:

    Jakob Creutzfeldt?

  11. Nancy says:

    Creutzfeldt-Jakob disease

  12. Meg the Pharmer says:


  13. Gregory House says:

    Is it a form of Prion disease? Creutzfeldt-Jakob would be the most likely.

  14. Jim Storey says:

    Ouch – Jakob Creutzfeld disease.

  15. Kenneth says:

    Early stages of dementia or AD? biopsy looks CJD