Abstract
We reported a patient with Creutzfeld-Jakob disease. The patient was a seventy-eight year-old woman, who had rapidly progressive dementia with myoclonus and fell into the condition of akinetic mutism. An electro-encephalogram showed periodic synchronized discharge. A diffusionweighted MRI showed high-intesity legions in the cerebral cortex and basal ganglia. In the liquor, 14-3-3 protein was detected. We diagnosed her as Creutzfeld-Jakob disease. She had fallen into respiratory and circulatory failure by acute pneumonia and her family members hoped that lifesustaining therapy would be available for her. We had informed them about the disease and conferred continuously together about terminal care for the patient. As a result of the conference, they decided against life-sustaining therapy.
Infection control guidelies for prion diseases have been exhibited, but many unkuown things still remain concerning infectivity of organs and secretions. And no guideline exists concerning the terminal care for the patients, which would depend on the decision of a patient or family member. We think that it would not be the best selection to accept life-sustaining therapy requested by family members of the patient with Creutzfeld-Jakob disease in the terminal stage. On the other haud, we can not simply refuse a request of the family because we do not have all the answers for managing the patients. Therefore, it is necessary for us to have a well-organized and well-informed talk with the family of the Creutzfeld-Jakob disease patient.
It is important for us to stay informed, and treat the patients with a reliable protection protocol.
