Bertolucci P H, Malheiros S F
Disciplina de Neurologia, Escola Paulista de Medicina, São Paulo, Brasil.
Arq Neuropsiquiatr. 1990 Jun;48(2):245-9. doi: 10.1590/s0004-282x1990000200019.
A 45 years-old woman presented with loss of initiative and memory, motivated cry and behaviour disturbance with childish traits, quickly progressive along 6 months until total apathy. An EEG showed periodic activity with bilateral triphasic waves against a flattened background activity suggesting Creutzfeldt-Jacob disease (CJD), but investigation for treatable causes of dementia disclosed hypercalcemia and hypophosphatemia. Further investigation showed a mass at the thyroid region that at surgery was identified as an oxyphilic cells adenoma. With electrolyte disturbance correction and posterior surgery there was normalization of both EEG and clinical status. Though it was previously reported mental confusion and EEG alteration associated with hyperparathyroidism we do not know of any previous case of confusion associated with periodic activity in EEG as in this disease. Hyperparathyroidism should be a differential diagnosis in every "de novo" case of CJD.
一名45岁女性出现主动性和记忆力丧失、哭笑失调及行为紊乱且带有幼稚特征,在6个月内迅速进展直至完全淡漠。脑电图显示在平坦的背景活动基础上出现双侧三相波的周期性活动,提示克雅氏病(CJD),但对可治疗的痴呆病因进行检查发现有高钙血症和低磷血症。进一步检查显示甲状腺区域有一个肿块,手术时确定为嗜酸性细胞腺瘤。随着电解质紊乱得到纠正以及后续手术,脑电图和临床状况均恢复正常。尽管之前有报道称精神错乱和脑电图改变与甲状旁腺功能亢进有关,但我们不知道之前有任何像本病这样脑电图周期性活动与精神错乱相关的病例。在每一例“新发”CJD病例中,甲状旁腺功能亢进都应作为鉴别诊断。