Of Illusions, Hallucinations and Creutzfeldt-Jakob Disease (Heidenhain’s Variant)

J Neuropsychiatry Clin Neurosci 17:1, Winter 2005

SIR: Sporadic Creutzfeldt–Jakob disease (CJD), a rare progressive neurodegenerative disorder whose classic features include dementia, ataxia, and myoclonus can initially present with nonspecific psychiatric symptomatology such as fatigue, anxiety or a change in personality in about one third of cases, sometimes leading to erroneous diagnoses of depression or psychosis, as has been described in single patient reports. 1 In contrast to the above psychiatric symptoms, the presence of visual perceptual abnormalities such as illusions and hallucinations observed at the onset of a patient’s clinical course is usually more likely to be viewed as indicative of a medical, ophthalmologic or neurologic illness rather than of psychiatric etiology.2 We present a case of an elderly female with an initial presentation notable for the acute manifestation of visual illusions followed by visual hallucinations, but whose complicated medical course led to a variety of psychiatric diagnoses prior to her ultimate diagnosis of CJD.

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