A 36-year-old male with a history of IV drug use presented to the hospital for left hand weakness and difficulty walking. Initial examination by neurology on Day 2 noted mild dysarthria, dysmetria in left lower extremity, mildly hyperreflexia, 4/5 left upper extremity weakness, and subtle left face and upper extremity twitching. MRI brain demonstrated bilateral diffusion restriction in a cortical ribboning pattern, most notable in the right temporal and occipital region, along with T2 hyperintensity of the right putamen. Lumbar puncture was preformed, and initial CSF studies were unremarkable.
Electroencephalogram was consistent with a mild generalized encephalopathy. On cumulative daily exams there was a progressive paralysis and sensory loss in left upper extremity, crossed adductor responses bilaterally in lower extremities, and altered mental status. On Day 7 based on the available data and progressive neurological decline, the patient was deemed to have “probable CJD” based on Center for Disease Control and Prevention’s (CDC) diagnostic criteria. On day 16, prion disease testing returned and reviled positive T-tau protein and 14-3-3 protein but negative RT-QuiC, lowering the probability of prion disease to <1%.
Upon further history gathering, it was revealed that the patient had a history of injecting methamphetamine into his right carotid artery. It was then felt that the patients clinical presentation was due to a delayed toxic encephalopathy from methamphetamine injection.