Sporadic Creutzfeldt-Jakob Disease Presenting as Stroke and Wernicke Encephalopathy: A Report of Two Cases

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare and fatal condition whose early clinical heterogeneity often leads to misdiagnosis as more common, potentially manageable disorders.We report two retrospective cases of unique adult patients with probable sCJD whose initial presentations mimicked ischemic stroke and Wernicke encephalopathy with paraneoplastic autoimmunity.Case 1 involves a woman in her early 70s who was treated for a presumed ischemic stroke for several months before the onset of rapidly progressive dementia.Cortical ribboning on magnetic resonance imaging (MRI) and markedly elevated cerebrospinal fluid (CSF) total-tau and 14-3-3 with a positive real-time quaking-induced conversion (RT-QuIC) assay supported the diagnosis.Case 2 describes a woman in her late 50s initially treated for suspected Wernicke encephalopathy.Following a positive P/Q-type voltage-gated calcium channel (VGCC) antibody test, she was treated for paraneoplastic cerebellar degeneration before CSF RT-QuIC and 14-3-3 later confirmed sCJD.sCJD should remain on the differential for rapidly progressive neurological decline, even when early features suggest stroke, thiamine deficiency, or paraneoplastic autoimmunity.