How would you explain the high signal on diffusion-weighted imaging?
It is thought that the changes in CJD seen on DWI represent the underlying pathophysiology of alterations in water molecule movement and restrictions in extracellular space due to spongiform change. Gliosis and deposition of prion protein may also contribute (Macfarlane et al., 2007).
There is T2/FLAIR hyperintensity and restricted diffusion involving the caudate head and anterior putamen bilaterally as well as the medial temporal lobes and limbic system. Normal ventricles, sulci and cisterns. Normal major venous intracranial flow voids. No abnormal enhancement. No other foci of restricted diffusion. This may favour a cause such as CJD.