system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 60-year-old woman presents to the emergency department with her husband. He is concerned that she has had abnormal behavior and involuntary movements of her body for the last 3 weeks. She now has difficulty remembering names, dates, and events. She even fails to recognize pictures of her children. She was in her normal state of health 3 weeks ago. There is no history of fever, headache, head trauma, drug abuse, or change in medications. Past medical history is significant for type 2 diabetes mellitus. She takes metformin and a multivitamin. Family history is negative for psychiatric illness. Her blood pressure is 134/87 mm Hg, the heart rate is 70/min, and the temperature is 37.1°C (98.8°F). The exam is occasionally disrupted by sudden episodic jerking of her limbs. She is drowsy but arousable to voice, and is disoriented and confused. Extraocular movements are normal. Cranial nerves are intact. There is no neck stiffness. Her laboratory results are significant for:
Hemoglobin 14.3 g/dL
White blood cells 6,900/mm3
Platelets 347,000/mm3
Creatinine 1.0 mg/dL
Sodium 146 mmol/L
Potassium 4.1 mEq/L
Calcium 9.1 mg/dL
Glucose (random) 132 mg/dL
TSH 2.5 mU/L
She is admitted to the neurology service. A head MRI, lumbar puncture, and EEG are performed. The MRI is nondiagnostic. Electroencephalography (EEG) reveals periodic spike and slow waves at an interval of 1 second. Cerebrospinal fluid is positive for protein 14-3-3. What is the most likely diagnosis?
assistant
Creutzfeldt-Jakob disease