Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan; Department of Otorhinolaryngology, Koshigaya Municipal Hospital, 10-32, Higashikoshigaya, Koshigaya-shi, Saitama, 343-8577 Japan.
Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan.
Auris Nasus Larynx. 2023 Jun;50(3):458-462. doi: 10.1016/j.anl.2022.04.005. Epub 2022 Apr 17.
Creutzfeldt-Jakob disease is a fatal transmissible prion disease of the central nervous system. Dizziness as an initial manifestation of Creutzfeldt-Jakob disease is rare. However, patients with Creutzfeldt-Jakob disease and dizziness may initially visit the otolaryngology department, but this is uncommon. We report the case of a 56-year-old woman with Creutzfeldt-Jakob disease who initially presented with dizziness as an emergency patient to the otolaryngology department. Primary position upbeat nystagmus was identified using a charge-coupled device camera with infrared illumination. Electronystagmography revealed impaired smooth pursuit and diminished optokinetic nystagmus. Based on these findings, we immediately suspected an intracranial cause of dizziness and reached a presumptive diagnosis of sporadic Creutzfeldt-Jakob disease, thus preventing severe transmission. This case emphasizes that Creutzfeldt-Jakob disease should be included as a differential diagnosis for patients with dizziness and abnormal eye movements, such as primary position upbeat nystagmus, which might be caused by intracranial disease.
克雅氏病是一种致命的中枢神经系统传染性朊病毒病。头晕作为克雅氏病的初始表现较为罕见。然而,克雅氏病伴头晕的患者可能最初会到耳鼻喉科就诊,但这种情况并不常见。我们报告了一例 56 岁女性克雅氏病患者,她最初以头晕为急症就诊于耳鼻喉科。使用带有红外照明的电荷耦合器件(CCD)摄像头发现了初始注视性眼震。眼震电图显示平滑追踪和视动性眼震受损。基于这些发现,我们立即怀疑头晕是由颅内原因引起的,并做出了散发性克雅氏病的初步诊断,从而避免了严重的传播。本病例强调,对于出现原发性注视性眼震等异常眼球运动的头晕患者,应将克雅氏病纳入鉴别诊断,此类异常可能由颅内疾病引起。