Detailed neurological examination is necessary in all patients of psychiatric illnesses , especially with more of atypical presentation or poor response to treatment , to rule out any of the infectious causes. In case of patients with psychiatric illnesses, with more of focal neurological deficits, one should consider the probability of any CNS infection. Patients with atypical presentation of Psychiatric disorder with neurocognitive abnormalities, aggressiveness, late onset with acute behavioral symptoms, and lack of previous history of psychiatric illness , there is a need to consider syphilis. A diagnosis of CJD should be considered when an adult patient develops dementia rapidly and myoclonus.

1. NEUROPSYCHIATRIC ASPECTS OF
INFECTIOUS (Other than HIV) &
PRION DISEASES
PRESENTER – DR. P. SRAVANTHI
CHAIR PERSON – DR.KAILASH.S
CHRI,
2018
1

2. OVERVIEW
 INTRODUCTION.
 NEUROSYPHILIS.
 MENINGITIS.
 TUBERCULOSIS.
 MALARIA.
 NEUROCYSTICERCOSIS.
 HSV ENCEPHALITIS.
 SSPE.
 FUNGAL INFECTIONS.
 OTHER INFECTIOUS DISEASES.
 PRION DISEASE.
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3. • H.Influenza , Meningococcus , Pneumococcus
• Brucellosis , Leptospirosis, Lyme disease, TB, Syphilis , Whipple disease
BACTERIAL
• CMV , EBV , HIV , HSV , Influenza , Flavi virus , Mumps , Measles , Rubella ,
Polio virus , Rabies virus , Papova virus
VIRAL
• Coccidioidomycosis , Cryptococcosis , Histoplasmosis , Candida
FUNGAL
• Cysticercosis , Malaria , Toxoplasmosis
PARASITIC
• CJD , Fatal Familial Insomnia , Kuru
PRION
INFECTIOUS CAUSES OF
NEUROPSYCHIATRIC DISORDERS
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4. NEUROPSYCHIATRIC
ASPECTS OF OTHER
INFECTIOUS DISEASES
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5. HISTORY
 In early 1900s, for the first time , an association between neuropsychiatric symptoms and
infectious organisms was made in patient with syphilis (Hideyo et.al), followed by patients
affected in viral influenza epidemic.
 Later many theories were put forth and research was done to find the etiology of
neuropsychiatric complaints in patients with infectious diseases.
 Few of the accepted mechanisms are – direct effect on CNS , autoimmune process, altered
neurotransmitter function, or influence of infectious organisms at a critical developmental
period .
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6. INTRODUCTION
 Infectious organisms can play an important role in pathophysiology of
neurodegenerative and neurobehavioral diseases 1
 Psychiatric symptoms can be associated with several systemic and central nervous
system infections and they can be the initial presenting symptoms, occurring in the
absence of neurological symptoms in some disorders2
 Maternal and childhood infections are considered as risk factors for psychosis 3
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7. RELATION BETWEEN INFECTIOUS
DISEASES AND PSYCHIATRIC
MANIFESTATIONS 4
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8. Possible Mechanism of Psychiatric
manifestations in Infectious diseases
Depressive
Symptoms 5
• As a process of immune response, IFN-gamma is responsible to activate
indoleamine-2, 3-dioxygenase and deplete tryptophan , which results in
decreasing serotonin production.
Delirium 6
• High levels of pro-inflammatory cytokines and cortisol in CSF
• Presence of elevated C-reactive protein
Psychotic
symptoms 7
• Following certain infections , there is up-regulation of MicroRNA-132 , which is
associated with changes in dopamine receptor signaling
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9. NEUROSYPHILIS
 Neurosyphilis (NS) occurs in up to 30% of people with untreated syphilis and may occur at
any stage of the infection
 It has a wide spectrum of neurocognitive symptoms that, apart from being non-specific, are
also common to many neurologic and psychiatric disorders which makes the diagnosis
difficult.
 The frequency of psychiatric symptoms associated with NS reported in literature ranges
from 33% - 86%. 7
 The most common presenting neuropsychological symptoms being personality change and
hallucinations (in 48% of patients).
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10. CLASSIFICATION OF NEUROSYPHILIS 8
• Syphilitic meningitis - result of direct meningeal
inflammation, rarely has focal findings.
• Meningovascular syphilis - ischemic changes caused
by proliferative endarteritis, causing permanent CNS
damage, and presents most commonly as a stroke
syndrome.
• Parenchymatous neurosyphilis (general paresis or
tabes dorsalis), there is direct neural destruction
resulting in diminished neuron concentration,
demyelination, and gliosis.
• Gummatous neurosyphilis, the mass effect causes
neurologic manifestations
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11. AS per ICD-10
 F02.8 : Dementia in other specified diseases classified elsewhere
Dementia can occur as a manifestation or consequence of a variety of cerebral and
somatic conditions.
Includes – Dementia in Neurosyphilis (A52.1)
 A50.4 Late congenital neurosyphilis [juvenile neurosyphilis]
 A52.1 Symptomatic neurosyphilis
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12. GENERAL PARESIS
(DEMENTIA PARALYTICA)
 Because of the cognitive loss and neuropsychiatric disturbances associated with tertiary neurosyphilis.
 Generally starts 10 to 20 years after infection, seen in 5-15% of patients.
 Spirochetes can be demonstrated in the tissues of the brain, and the pathology is thought to be due to
the irritation produced by these spirochetes in the brain parenchyma.
 Neuroimaging studies 9
• Frontocortical atrophy and disseminated high signal lesions in a frontal distribution;
• SPECT imaging reveals a marked reduction in cerebral perfusion, particularly in the bilateral
frontal and temporal cortices.
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13. CLINICAL FEATURES
 Prodromal symptoms (Headache , insomnia , lethargy )
 Insidious change in the personality ( apathy , emotional lability , irritability)
 Delirium
 Episodic forgetfulness – first cognitive change
 Other cognitive changes:
 Difficulty with calculation
 disturbances of speech and writing
 Impaired insight
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14. SIMPLE DEMENTING FORM 10
 Impairment of memory
 Early loss of insight
 Delirium
 Associated with mild euphoria or apathy or fleeting, ill-systematized persecutory
delusions.
 The patients are mostly quiet, lethargic and amenable throughout the course of
the disease.
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15. GENERAL PARESIS PRESENTING AS OTHER
FORMS 10
• More of elated mood , grandiose delusions.
• If his beliefs are questioned, the mood readily turn to irritability
or anger.
EXPRESSIVE
OR
GRANDIOSE
FORM
• Low mood, Suicidal thoughts, Delusions (Nihilism ,
hypochondriacal or guilt)
• Symptoms are out of proportionate to signs
DEPRESSIVE
FORM (27%)
• Delusion of persecution – more common
• Associated with schizophrenic symptoms like – somatic passivity
,commanding hallucinations.
PSYCHOTIC
FEATURES
(Very rare)
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16. NEUROLOGICAL FEATURES ON
EXAMINATION 11
 Abnormal pupils
 Tremors
 Dysarthria
 Deep tendon reflex abnormalities
 Cerebellar signs ( incoordination ,Gait ataxia, Positive Romberg’s sign )
Other conditions may be associated :
Seizures
Hemiparesis
Autistic features
Parkinsonism features
Huntington's chorea
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17. MANAGEMENT
 Goal - to reverse the manifestations or arrest the disease progression.
 Any psychiatric medication – to be started in low dose and monitored for side-effects
 Anti-psychotics - Quetiapine and Aripiprazole preferred.
 ECT – AVOIDED (worsens neurological signs & impaired overall prognosis)
 Rehabilitation (if deficits persist)
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18. MENINGITIS
 Meningitis commonly presents with Pyrexia & neck stiffness , hence diagnosis is not missed.
 In general , 95% of individuals present with at least two of the four cardinal symptoms:
headache, fever, neck stiffness and altered mental status.
 However, in some conditions, the presenting complaints may be vague and presents with altered
sensorium or personality changes.
 Broadly 3 types of meningitis are discussed – Bacterial , Aseptic and Tubercular meningitis.
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19. MENINGITIS
Inflammation of Meninges
Disrupted blood supply to nerve cells(affected by toxins)
Damage to nerve cells
Fluid leak into brain tissue
Brain swelling
Raised ICT
Interrupt oxygen supply to brain tissue
That part of the brain is injured or damaged
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20. MENINGITIS EARLY
SYMPTOMS
PSYCHIATRIC
SYMPTOMS
Other features Neurological
abnormality
BACTERIAL 12
(Neisseria meningitidis,
Streptococcus pneumoniae,
Staphylococcus aureus, Haemophilus
infl uenzae and E. coli)
Headache ,
vomiting,
photophobia,
irritability
Delirium,
Fatigue, Depression,
Personality change,
mood lability
Cerebellar
symptoms;
Sluggish DTRs;
Seizures
Damage in
Cortical and
subcortical areas
ASEPTIC 12
Most common - Viral
(Enterovirus; HSV;VZV;EBV)
(Rarely - early stages of TB
meningitis, brain abscess,
neurosyphilis, leptospirosis)
Malaise
Fever
Muscle and joint
aches
Tiredness, Irritability,
Reduced
concentration, Mood
swings and
Depression
Recurring
headaches.
TUBERCULAR 13
Prodromal phase
(headache ,
Anorexia)
Apathy, Psychosis,
irritability and
insidious change of
personality.
Coarse Tremors,
Abnormal
reflexes,
3,6,7 cranial
nerve palsies,
Hemiplegia,
Seizures,
Papilledema
Subependymal
Tubercles;
Rupture of bacilli
into sub-
arachnoid
hemorrhage.
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21. NEURO-PSYCHIATRIC SYMPTOMS
AS SEQUALAE OF MENINGITIS 14
BACTERIAL • Insomnia
• Cognitive impairment
• Depression
ASEPTIC • Depression
• Insomnia
• Anxiety
• Neuro-cognitive impairment
TUBERCULAR Retrograde Amnesia and
amnesia for active illness
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22. COGNITIVE IMPAIRMENT 15
 Generally seen in patients with both bacterial and viral , more common with bacterial
(Pneumococcal and meningococcal meningitis - around 30%)
 Domains involved are:
• Impairment of memory
• Decreased psychomotor performance
• Impaired attention/executive functions
• Reduction in visuoconstructive capacity
 Male sex and cranial nerve involvement were predictors of poor cognitive outcomes.
In Children :
• Persistent learning difficulties
• Deficits in Short-term memory
• Poor Academic performance
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23. TUBERCULOSIS
 Chronic infectious multi systemic disease caused by mycobacterium tuberculosis and is one of the
leading causes of mortality worldwide
 A higher rate of mortality and morbidity was seen among patients with baseline psychiatric illness ,
because they defaulted from treatment
 There is a high prevalence of psychiatric illness in TB patients, but primary care physicians and
specialists do not screen this association although anxiety and depression occur frequently in
persons with these cases.16
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24. NEUROPSYCHIATRIC MANIFESTATIONS 17
 Prevalence in patients with TB – 31%
• Depression (19-26%)- Most common
• Anxiety
• Substance Use Disorder
• Personality changes
 Co-infection with HIV may significantly increase the risk of depression by up to 70%
 Associated with
• increase in the number of symptoms reported
• more serious perceived consequences
• less control over the illness
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25. Psychological reaction to the diagnosis or
treatment (TB)
1. Social stigma
• External: rejection, blame &
discrimination
• Internal: shame, guilt, social
withdrawal, isolation, depression
2. Social/occupational/functional impairment
3. Infectiousness/household exposure
Vulnerable populations
 Poverty
 Seriously mentally ill
 Homeless
 Co infected with HIV
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26. PSYCHIATRIC MANIFESTATIONS
DUE TO ANTI TUBERCULAR DRUGS 18
ISONIAZID
• Depression
• Irritability
• Psychosis
• OCD
• Attempted suicide
ETHIONAMIDE
• Depression
• Anxiety
• Psychosis
• Suicide
ETHAMBUTOL
• Mania
• Confusion
• Psychosis
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27. MALARIA
 Malaria can sometimes be presented with unusual
features
1. due to the development of immunity
2. the increasing resistance to anti-malarial drugs
3. the indiscriminate use of antimalarial drugs.
 Cerebral malaria is the most dreaded and a potentially
life-threatening complication.
 Cerebellar ataxia, extrapyramidal rigidity and various
psychiatric symptoms have been described either as the
early manifestations of cerebral malaria or as a part of
the post malaria neurological syndrome
19
.
• Endothelial
damage
Induction of
NO
• Alteration of Vascular
Permeability
Inhibits NMDA channel
in post-synaptic cell.
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28. NEUROPSYCHIATRIC MANIFESTATIONS 20
RISK FACTORS
• High grade fever
• Alcohol
• Financial or inter
personal stressors
• Exacerbation of pre-
existing psychiatric illness
Symptoms/Disorders
• Acute psychosis
• Mania
• Delirium
• Catatonic symptoms
• Mood disorders (rare)
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29. MALARIAL PSYCHOSIS 20
 Develops because of encephalopathy in patients with cerebral malaria.
 Manifests as paranoid and manic syndromes in the acute stage, depression being a late
sequelae.
 Agitation and confusion may develop after the patient has recovered from coma.
 Sometimes, these psychiatric manifestations may be the presenting features in patients with
acute uncomplicated malaria, especially in association with hyperpyrexia
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30. Post-Malaria Neurological Syndrome (PMNS) 21
 Seen after symptomatic malarial infection & clearance of parasites from blood.
 It is characterized by development of neurological and psychiatric symptoms that can occur 1
- 4 months after exposure.
 Clinical manifestations:
o GTCS
o Delayed cerebellar ataxia
o Psychosis
o Tremors
 Generally seen in patients with severe malaria and those treated with mefloquine treatment
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31.  Neuropsychiatric impairments due to cerebral malaria in children :
 Long-term cognitive impairment
 Acquired language disorder
 Inattention
 Impulsiveness and hyperactivity
 Conduct disorders
 Impaired social development
 Obsessive symptoms
 Self-injurious behaviors
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32. PSYCHIATRIC MANIFESTATIONS
DUE TO ANTI MALARIAL DRUGS
MEFLOQUINE
22
• Anxiety
• Paranoia
• Depression and
suicidality
• Hallucinations, and
psychotic Behaviour
CHLOROQUINE
23
• Increased psycho-
motor activity
• Disorientation
• Incoherent speech
• Confusion
• Outbursts of abnormal
behavior
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33. NEUROCYSTICERCOSIS
 Common neuroparasitic infection with a worldwide distribution.
 Endemic in rural areas of the developing countries of Asia, Africa, Latin America, and central
Europe.
 Characterized by the deposition of cysticerci in the brain as a result of eating of undercooked
pork.
 Responsible for nearly half of the late onset cases of epilepsy in the endemic areas and is also
associated with psychiatric manifestations 24
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34.  Parietal lobe was the most affected area, followed by frontal lobe and disseminated lesions. 25
 Left sided lesions were associated with more psychiatric morbidity.
 Neuro-psychiatric Manifestations:
 Focal seizures (68%)
 Depression (52%)
 Psychotic disorders(14%)
 Cognitive impairment(80%)
 Catatonic or manic symptoms
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35. HSV ENCEPHALITIS
Causative organism HSV -2 virus
Population Neonatal and immunocompromised
Clinical presentation Acute fever , with delirium , behavioral abnormalities like
personality changes, hallucinations, florid psychotic symptoms.
Focal deficits can result in seizures or myoclonus
Kluver-Bucy Syndrome
EEG Periodic temporal spikes and slow waves
MRI Diffuse inflammation (temporo-parietal region) 26
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36.  The prominence of psychiatric disturbance is seen characteristically when the pathology is seen in
the temporal lobes and orbitofrontal structures . 27
 Thus, focal symptoms such as anosmia, olfactory and gustatory hallucinations, or marked memory
disturbance out of proportion to the impairment of intellect can also be seen.
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37. SUBACUTE SCLEROSING
PANENCEPHALITIS 28
 21 cases per million in India.
 The majority of cases have a history of measles infection.
 More common in children or adolescent age group.
 The initial features of the illness include more subtle cognitive impairment deteriorating into
behavioral disturbance and clear-cut dementia.
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38. Neuropsychiatric manifestations
 Insidious intellectual impairment
 Poor academic performance
 Problems in memory and attention
 Nocturnal delirium with hallucinations
 Marked lethargy
 Occasional disinhibition or irritability
 Hypersexuality
Neurological signs:
• Myoclonic jerks of the face, fingers and
limbs
• Athetosis or rapid torsion spasms of the
trunk that lead to sudden stumbles and
falls
• B/L extrapyramidal signs.
• Seizures.
• Aphasia, Apraxia, Akinetic mutism.
EEG : Typically there are high-voltage slow-
wave complexes, synchronous in all leads,
and occurring at fixed intervals of 5–10
seconds along with the myoclonic jerk
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39. FUNGAL INFECTIONS 30,31
Cryptococcal meningitis
 Triad of headache, fever and vomiting with Altered sensorium(13-73%)
 Neuropsychiatric manifestations may be due to meningeal cryptococcosis and raised intracranial
pressure.
 Psychosis most commonly seen (Acute / Brief psychotic episode); Occasionally mania or depression
with psychotic symptoms seen.
Candida infection – Schizophrenia, BPAD , Memory disturbances
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40. OTHER INFECTIOUS DISEASES 3
DISEASE TYPICAL SYMPTOMS PSYCHIATRIC
MANIFESTATIONS
BRUCELLOSIS 32
Malaise, headache, weakness,
myalgia and night sweat,
Lymphadenopathy,
hepatosplenomegaly, spinal
tenderness, sacroiliitis.
Behavioral changes,
Psychosis, stupor, Delirium.
Depression is common in
untreated chronic forms of
brucellosis.
LEPTOSPIROSIS Headache, Malaise, Fever,
Anorexia, Myalgia,
Hepatosplenomegaly,
Lymphadenopathy, Skin rash.
Delirium
Mania & Psychosis
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41. OTHER INFECTIOUS DISEASES 3
DISEASE TYPICAL SYMPTOMS PSYCHIATRIC
MANIFESTATIONS
LYMES DISEASE 33
(Lyme Borreliosis)
Erythema migrans
(at the site of tick bite)
Depression, Dementia,
Schizophrenia, BPAD , Hyper
somnolence, panic attacks,
anorexia nervosa and OCD.
TOXOPLASMOSIS 4
Fever, Myalgia and Malaise
Pneumonia, Myocarditis and
Choroidoretinitis
Delirium, Depression , Anxiety,
Psychosis
WHIPPLE’S DISEASE Arthralgia, Diarrhea, Weight loss Depression, Personality
changes, Dementia
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42. NEUROPSYCHIATRIC
ASPECTS OF PRION
DISEASES
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43. CASE VIGNETTE 34
 62-year-old man had become withdrawn, apathetic,
with poor sleep over 2 months.
 His GP started treatment with citalopram for a
suspected depressive illness.
 Gradually patient became increasingly confused and
agitated and reported seeing frightening people and
animals. On several occasions, he left the house to
chase these intruders away and became lost
 He also developed involuntary muscle jerks of the
limbs, and his balance deteriorated.
 Citalopram was stopped attributing the symptoms to
an adverse drug reaction, but this did not lead to any
improvement.
 During a 2-week IP stay in the hospital, extensive
investigations were undertaken, and a diagnosis of
probable sporadic Creutzfeldt-Jakob disease (CJD)
was made.
 Visual hallucinosis with associated agitation and
behavioral disturbance continued and the patient
had several falls on the ward as a result of
attempts to move around despite increasing
ataxia and apraxia
 Risperidone was initiated at a low dosage, and
within a few days the patient’s agitation and
psychotic symptoms had lessened and patient
got discharged.
 Back at home, the patient’s mobility and
cognitive function continued to steadily decline,
and he became increasingly dependent on his
family and caregivers.
 Had increased daytime somnolence, became
bedbound and mute.
 Was agitated and had dramatic stimulus-
sensitive myoclonus. (improved with Clonazepam
low dose)
 Patient expired 8 months after the onset of the
first symptoms of withdrawal and apathy.
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44. INTRODUCTION
 Transmissible spongiform encephalopathies (TSEs)
 Unique infectious and invariably fatal neurodegenerative disorders of humans and animals
that result from the misfolding of a normal cell protein(PrPc) into an abnormal protein
(PrPSc).
 Share a spongiform degeneration of the brain and a variable amyloid plaque formation
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45. • CJD
• Fatal Insomnia
Sporadic(85%)
• Familial CJD
• FFI
Genetic(14%)
• Kuru
• Iatrogenic CJD
• Variant CJD
Acquired(1%)
HUMAN PRION DISEASES
FFI
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46. CREUTZFELDT-JAKOB DISEASE
35,36,37
 A progressive dementia with extensive neurological signs, due to specific neuropathological
changes (subacute spongiform encephalopathy) that are presumed to be caused by a
transmissible agent.
 Onset is usually in middle or later life, typically in the fifth decade, but may be at any adult
age.
 The course is sub acute, leading to death within 1-2 years.
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47. SPORADIC CJD
 Arises from either spontaneous prion gene
(PRNP) somatic mutation or stochastic prion
protein (PrP) structural change.
 Affects men and women equally with average age
of onset is 60 years
 Psychiatric manifestations
 as early presentation seen in 18-39%
 At any Stage of illness in 89%
Supportive of Diagnosis:
 EEG- synchronized biphasic or triphasic
sharp wave complexes
 Presence of 14 - 3 – 3 protein in CSF
 Poor prognosis
 Mean duration to onset of symptoms to
death is 6 months (3-12 months)
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48. VARIANT CJD
 Transmitted through blood transfusion
 Presents with a relatively slow clinical
course.
 Somatosensory-evoked responses may
demonstrate minor abnormalities,
indicating central involvement of pain
pathways or thalamic origin for the pain.
 Psychiatric manifestations seen in almost
all the patients and is considered as one
of the diagnostic criteria for vCJD.
 Median duration of survival - 13 months.
IATROGENIC CJD
 Accidental transmission of CJD through surgery or
medical procedure
 Also be transmitted to humans by using
inadequately sterilized neurosurgical instruments.
 In cases of central transmission (use of inadequately
sterilized neurosurgical instruments or implanted
EEG electrodes) patients mainly manifest with
cognitive decline
 While in peripheral cases such as transmission of
CJD via injection of contaminated HGH or
gonadotropins, progressive ataxia followed by
dementia predominate the clinical picture.
 Majority of these patients develop myoclonic jerks
 Psychiatric symptoms are relatively rare.
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49. CLINICAL FEATURES
Early
Symptoms
Systemic
(1/3)
Behavioral
Or
Cognitive
(1/3)
Focal
(1/3)
Late signs of the disease
 progressive immobility
 cortical blindness
 Dysphagia
 Akinetic mutism
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50. DEMENTIA
36
 Rapidly progressive (usually in weeks)
 Rapidly worsening confusion, disorientation.
 Problems with memory, thinking, planning and judgment.
 Generally associated with hallucinations.
 Other behavioral symptoms seen generally in later stages :
• Agitation (episodic) associated with stimulus induced myoclonus
• Wandering behavior
• Repetitive vocalizations
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51. PSYCHOTIC SYMPTOMS (36.9%)
• Visual hallucinations (+/- other visual
complaints)
• Hallucinations in other modalities
• Extra-campine hallucinations (secondary to
delusional content)
• Delusions ( persecution / infidelity)
MOOD SYMPTOMS (41.7%)
 social withdrawal
 Irritability
 Anxiety
 low mood
 Suicidal ideas
 Emotional lability
 More in FEMALES
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52. As per ICD-10 (F02.1)
(Dementia in Creutzfeldt-Jakob disease)
 Suspected in all cases of dementia that progresses fairly rapidly over months to 1 or 2 years and that is
accompanied or followed by multiple neurological symptoms.
 In some cases, such as the so-called amyotrophic form, the neurological signs may precede the onset of
the dementia.
 There is usually a progressive spastic paralysis of the limbs, accompanied by extrapyramidal signs with
tremor, rigidity, and choreoathetoid movements.
 Other variants may include ataxia, visual failure, or muscle fibrillation and atrophy of the upper motor
neuron type.
 The triad consisting of - rapidly progressing, devastating dementia, - pyramidal and extrapyramidal
disease with myoclonus, and - a characteristic (triphasic) electroencephalogram is thought to be
highly suggestive of this disease.
 The rapid course and early motor involvement should suggest Creutzfeldt-Jakob disease.
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53. PSYCHIATRIC MANIFESTATIONS NEUROLOGICAL & OTHER
MANIFESTATIONS
FATAL
FAMILIAL
INSOMNIA 37
Dementia may or
may not be seen
Insomnia (severe- visual fatigue & Diplopia)
Personality changes (Apathy)
Disturbances of attention and vigilance and
working memory
Autonomic disturbances including develop.
Major motor abnormalities consist of ataxia,
spontaneous and evoked myoclonus.
Reduced ACTH & Increased se. cortisol
KURU
37
Dementia seen
only in advanced
stages
Seen in later stages
Emotional incontinence with inappropriate
laughter
Apathetic and withdrawn.
Gait ataxia is accompanied by dysmetria ,
dysarthria leading to frequent falls until the
individual can no longer walk independently
or sit without support.
various Other movement disorders such as
clonus, chorea, and athetosis, and convergent
strabismus
No weakness or rigidity
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54. Treatment For prion diseases
38
 Symptomatic and palliative treatment
For psychiatric symptoms
 Anti – depressants (better tolerated)
 Anti – Psychotics ( increased chance of side-effects ; short term )
 Benzodiazepines and Sodium Valproate
(Preferred when psychotic symptoms a/w neurological complains; long term in low doses under
supervision)
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55. TAKE HOME POINTS
 Detailed neurological examination is necessary in all patients of psychiatric illnesses ,
especially with more of atypical presentation or poor response to treatment , to rule out any of
the infectious causes.
 In case of patients with psychiatric illnesses, with more of focal neurological deficits, one
should consider the probability of any CNSinfection.
 Patients with atypical presentation of Psychiatric disorder with neurocognitive abnormalities,
aggressiveness, late onset with acute behavioral symptoms, and lack of previous history of
psychiatric illness , there is a need to consider syphilis.
 A diagnosis of CJD should be considered when an adultpatientdevelopsdementiarapidlyand
myoclonus.
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