Creutzfeldt-Jakob disease secondary to dural graft performed in 1988.

The patient was a 51-year-old male with a history of Arnold-Chiari I malformation and syringomyelia from C1 to T3. In October 1988, he was treated with laminectomy, amygdalectomy, and duraplasty. Gait alteration secondary to mild spastic paraparesis manifested as a long-term sequela. In August 2012, the patient presented symptoms of altered behavior, including irritability, mood swings and apathy. He had been diagnosed with depressive syndrome several years earlier. His mirtazapine treatment had been suspended 1 month before that date, when he underwent shoulder arthroscopy. In mid-September of 2012, the patient first visited the emergency department due to symptom progression; he presented aggressiveness, difficulty planning activities of daily living, Dear Sir, Creutzfeldt-Jakob disease (CJD) is a neurodegenerative process produced by the deposition of a pathological isoform of a prion protein. There are three subtypes of CJD, broken down by etiology: sporadic (87%), genetic (8%), and acquired (5%) [1] . The latter subtype includes variant CJD (vCJD) and iatrogenic CJD (iCJD). To date, over 400 cases of iCJD have been described in more than 20 countries [2, 3] . Most reported cases were secondary to treatment with cadaveric human growth hormone or lyophilized cadaveric dura mater grafts [3] . Other, less frequent, sources of iCJD infections have included corneal transplants, electrodes used in stereotaxic electroencephalography, contaminated neurosurgical instruments, and transfusions of blood products [3] . The incidence of iCJD cases has decreased significantly in recent years thanks to the adoption of safety measures, and only isolated cases have been published in a few countries [3] . Six cases have been reported in Spain since 1993, when the National Spongiform Encephalopathy Registry was created by Instituto de Salud Carlos III (Madrid). All cases were caused by lyReceived: December 13, 2013 Accepted: January 13, 2014 Published online: June 12, 2014