66 year old with progressive cognitive and neurological decline, becoming catatonic within 2 months.
MRI DWI [1, 2, 3] shows cortical ribboning (cortex diffusion restriction [1]), and diffusion restriction in the deep gray nuclei and insula [2, 3] in a symmetric fashion.
MRI FLAIR [4] shows abnormal bright signal at the sites of diffusion restriction.
MRI postcontrast T1 [5] and SWI [6] are normal.
Based on the above findings, there was a strong suspicion this was something bad. A lumbar puncture was performed under appropriate infection control guidelines. Results showed positive CSF results for 14-3-3, T-tau protein, and RT-QuIC. The patient had already been discharged to a nursing facility when these results came back, so the nursing facility was notified as well as the public health department. The patient was placed on comfort care.
Final diagnosis: sporadic Creutzfeldt-Jakob disease (CJD).
It's also rumored to be the source of the folklore about wendigos. People turn to cannibalism in the north countries during winter time if food ran out and it was a warning story about cannibalizing others