The Authors Reply Thank you for your letter regarding our case report (1). We diagnosed the present patient with corticobasal syndrome (CBS) with underlying Alzheimer's disease pathology (CBS-AD) because amyloid positron emission tomography revealed the accumulation of amyloid beta in the bilateral cerebral cortices. However, while this case met the diagnostic criteria for CBS, we also observed the typical features of dementia with Lewy bodies (DLB), i.e. fluctuating cognition, visual hallucinations, and Parkinsonism. Although we believe that our case was one of CBS with underlying Lewy-related pathology, we cannot be certain of this because the results of a [123I]-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) single-photon emission computed tomography (SPECT) and meta-iodobenzylguanidine (MIBG) myocardial scintigraphy do not completely support the diagnosis of DLB.
We agree that it should be noted that differential diagnoses cannot be based solely on imaging results, and there are DLB cases with normal 123I-FP-CIT SPECT findings and MIBG myocardial scintigraphy. Your study described four cases of diffuse Lewy body disease with antemortem CBS and concomitant severe AD pathology (2). Although our case did not have the same pathology, it was similar to these reported cases. Therefore, our case may indeed have been CBS underlying mixed Alzheimer's and Lewy-related pathology, as indicated in the Letter to the Editor and the report.
Again, thank you for your important comments.
The authors state that they have no Conflict of Interest (COI).
Financial Support
This work was supported by grants-in-aid from the Gifu University Graduate School of Medicine.
References
- 1. Nishida H, Hayashi Y, Harada N, Sakurai T, Wakida K. Diagnosing corticobasal syndrome based on the presence of visual hallucinations and imaging with amyloid positron emission tomography. Intern Med 57: 605-611, 2018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Kasanuki K, Josephs KA, Ferman TJ, et al. Diffuse Lewy body disease manifesting as corticobasal syndrome: a rare form of Lewy body disease. Neurology 91: e268-e279, 2018. [DOI] [PMC free article] [PubMed] [Google Scholar]