• Neeraj Kumar, Bradley F Boeve, Brendon P Boot, Carolyn F Orr, Joseph Duffy, Bryan K Woodruff, Anil K Nair, Jay Ellison, Karen Kuntz, Kejal Kantarci, Clifford R Jack, Barbara F Westmoreland, Julie A Fields, Matthew Baker, Rosa Rademakers, Joseph E Parisi, and Dennis W Dickson.
• Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
• Arch. Neurol. 2011 Sep 1;68(9):1165-70.

ObjectiveTo report the clinical, electroencephalographic, and neuroradiologic findings in a kindred with a novel insertion in the prion protein gene, PRNP.DesignClinical description of a kindred.SettingMayo Clinic Alzheimer Disease Research Center (Rochester, Minnesota).SubjectsTwo pathologically confirmed cases and their relatives.Main Outcome MeasuresClinical features, electroencephalographic patterns, magnetic resonance imaging abnormalities, genetic analyses, and neuropathologic features.ResultsThe proband was a woman with clinical and neuroimaging features of atypical frontotemporal dementia and ataxia. Generalized tonic-clonic seizures developed later in the disease course, and electroencephalography revealed spike and wave discharges but no periodic sharp-wave complexes. Her affected sister and father also exhibited frontotemporal dementia-like features, and both experienced generalized tonic-clonic seizures and gait ataxia late in the disease course. Genetic analyses in the proband identified a novel defect in PRNP, with 1 mutated allele carrying a 288-base pair insertion consisting of 12 octapeptide repeats. Neuropathologic examination of the proband and her sister revealed prion protein-positive plaques and widespread tau-positive tangles.ConclusionsThis kindred has a unique combination of clinical and neuropathologic features associated with the largest base pair insertion identified to date in PRNP and underscores the need to consider familial prion disease in the differential diagnosis of a familial frontotemporal dementia-like syndrome.

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