Female, 66 years old, with behavioral changes. Cortical gyriform restricted diffusion is seen throughout a majority of the right cerebral hemisphere, though particularly affecting the parietal, occipital and temporal lobes. Of note, the abnormality does not conform to any particular vascular territory. Scattered small areas of cortical restricted diffusion are seen in the left cerebral hemisphere. In addition, there is bilateral and symmetric restricted diffusion of the caudate nuclei and putamina. There may be minimal restricted diffusion along the dorsomedial thalami as well.Most of the above-mentioned areas demonstrate corresponding FLAIR hyperintensity. In addition, there are numerous scattered foci of white matter T2 hyperintensity which do not correlate with diffusion restricting lesions. No evidence of significant generalized mass effect is seen. No evidence of intracranial hemorrhage is detected. There are no abnormal extra axial fluid collections. Ventricular size and morphology are within normal limits. No pathologic intracranial enhancement is observed though postcontrast images are motion degraded.
The constellation of findings, including cortical gyriform restricted diffusion, as well as restricted diffusion involving the caudate nuclei, putamina, and perhaps the dorsomedial thalami, is highly suggestive of CJD. Other infectious etiologies, particularly viral, may also be considered. An ischemic etiology is considered unlikely.