CSF Pleocytosis and Syndrome of Inappropriate Antidiuretic Hormone Secretion in Creutzfeldt-Jakob Disease

A 71-year-old woman was admitted with cognitive and gait decline that progressed rapidly to the point of disability within less than a year. Her family first noticed slowing of her gait 7 months prior to admission. She subsequently began to fall and developed problems with memory characterized by repeatedly asking the same questions. Physical examination revealed moderate hypophonia and hypomimia. She was oriented only to person and had poor delayed recall with otherwise preserved language, attention, and visuospatial reasoning. Strength, sensation, tone, and reflexes were normal. Rapid alternating movements were bradykinetic bilaterally, and she had bilateral dysmetria on finger-nose and heel-shin testing that was worse on the left. Bilateral postural and action tremor was present, but there was no spontaneous or stimulus-induced myoclonus. She exhibited profound postural instability with a tendency towards retropulsion and a narrow-based, shuffling gait with freezing and en bloc turning.