# Referral of a Patient With Ocular Symptoms to the Stroke Clinic: Not Always the Usual Suspect!

## TL;DR

A 77-year-old man with visual symptoms was initially thought to have a stroke but was later diagnosed with a rare form of prion disease.

## Contribution

The paper presents a rare case of Heidenhain Variant Creutzfeldt-Jakob disease misdiagnosed as a stroke.

## Key findings

- The patient's symptoms were initially attributed to an occipital stroke but were later identified as HV-CJD.
- HV-CJD can present with visual changes and rapid cognitive decline.
- The case underscores the importance of considering rare prion diseases in differential diagnosis.

## Abstract

A 77-year-old male attended the stroke clinic as a delayed presentation of a stroke and was initially managed as an occipital stroke. He presented with a gradual decline in visual acuity with an initial suspicion of field deficit over a period of three to four months. He underwent extensive tests including imaging for a confirmatory diagnosis. He had a rapid deterioration of his vision, function, and cognition over a few weeks resulting eventually in death. The case highlights a rare variant of sporadic Creutzfeld-Jakob disease (sCJD), the Heidenhain Variant (HV-CJD). CJD is the commonest of human prion diseases. In HV-CJD, pathologic prions display demyelinating neurotropism for the occipital lobes resulting in visual changes and hallucinations.