Creutzfeldt-Jakob disease after receipt of a previously unimplicated brandof dura mater graft

Background: Iatrogenic Creutzfeldt-Jakob disease (CJD) transmission via dur a mater grafts has been reported in many countries. In September 1998, a 39 -year-old Colorado woman was reported as having suspected CJD after receivi ng a dura mater graft 6 gears earlier. Methods: An investigation was initia ted to confirm the diagnosis of CJD and assess the possible source of CJD t ransmission. The authors determined the presence or absence of other known CJD risk factors, checked for epidemiologic evidence of possible CJD transm ission via neurosurgical instruments, and evaluated the procedures used in the collection and processing of the graft, including whether the donor may have had CJD. Results: The CJD diagnosis was confirmed in the dural graft recipient by neuropathologic and immunodiagnostic evaluation of the autopsy brain tissue. She had no history of receipt of cadaveric pituitary hormone s or corneal grafts or of CJD in her family. The authors found no patients who underwent a neurosurgical procedure within 6 months before or 5 months after the patient's surgery in 1992 who had been diagnosed with CJD. The du ra mater was obtained from a 57-year-old man with a history of dysarthria, ataxia, and behavioral changes of uncertain origin. The graft was commercia lly prepared by use of a process that included treatment with 0.1 N sodium hydroxide and avoided commingling of dura from different donors. Conclusion s: The patient's age, absence of evidence for other sources of CJD, the lat ent period, and the report of an unexplained neurologic illness in the dono r of the dura mater indicate that the graft was the most likely source of C JD in this patient.