Tc-99m-bicisate (ECD)-brain-SPECT in rapidly progressive dementia

We present a 61-year-old male patient with progressive dementia. A brain SP ECT with Tc-99m-bicisate was performed for confirmation of clinically suspe cted Alzheimer-dementia. At the lime of the SPECT-investigation marked apra xia and aphasia besides severe dementia were present. Electrophysiological as well as anatomical neuroimaging findings showed non-diagnostic alteratio ns. SPECT revealed distinct perfusion defects, which made Alzheimer Dementi a unlikely. The further course of the patient was determined by rapidly pro gressive deterioration with development of akinetic mutism. Thereafter incr eased levels of neuron-specific enolase as well as 14-3-3 proteins were fou nd in the cerebro-spinal fluid (CSF). The patient finally died with signs o f cerebral decortication. Due to the clinical course and the CSF-findings t he patient's final diagnosis was Creutzfeldt-Jakob-disease, nevertheless no autopsy was performed. The presented case report underscores the clinical utility of perfusion brain SPECT in the differential diagnosis of dementias .