Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words:

69-year-old woman, a history of gait disturbance. Within the onset of gait difficulty, the family also noticed a symmetrical tremor in her hands and slowness of movements during daily activities accompanied by frequent falls.
About a month after the initiation of her symptoms, she reported a strange sensation inside her body without any objective phenomenon that was described as “chills inside her body.” Afterward, behavioral change became apparent in the form of delusion of persecution, changes in personality, and feelings of fear without reason. She became paranoid about others and had less confidence in close relatives.
A few months later, her gait worsened with the need for a walking aid and intensified tremors in both hands and her chin. Progressively she lost the ability to walk without help, and generalized myoclonic jerks appeared.
Notably, her past medical history included breast cancer diagnosed 2 years before this admission. She has undergone lumpectomy and chemoradiotherapy and, subsequently, oral tamoxifen. The follow-up had not shown any evidence of the relapse of the tumor.

After 8 months of initial presentation, the neurological examination revealed an awake and alert lady but not completely oriented to time and place. The Mini-Mental Status Examination (MMSE) score was 13 out of 30. Rigidity and bradykinesia were detected symmetrically on both sides. She had a resting tremor in both hands and her chin. The gait examination revealed a stooped posture with a short stepping gait and occasional freezing. Deep tendon reflexes were all symmetrically +1 to +2, and plantar reflexes were downward bilaterally. Although the sensory examination revealed no remarkable findings, the patient stated distal paresthesia of the upper limbs. Other positive findings in the examination were grasp reflex, utilization behavior, and the Myerson sign.

After admission, a comprehensive workup was performed with the clinical features of rapidly progressive dementia, parkinsonism, behavioral change, and frontal release signs. Blood and urine tests were normal, including electrolytes, liver, and kidney function tests, and level of vitamin B12. Tests for systemic vasculitis were all negative. Thyroid function tests and Anti-thyroid peroxidase antibody were in the normal range. According to the history of breast cancer, paraneoplastic and autoimmune antibodies in the blood and cerebrospinal fluid (CSF) were assessed, which showed no positive result. CSF analysis revealed no white blood cells and normal values for glucose and protein (39 mg/dL). The complementary tests revealed that the 14-3-3 protein was positive in CSF.

The brain MRI showed T2 and FLAIR hyperintensities in bilateral caudate, putamina, and medical thalami with water restriction in Diffusion-weighted imaging (DWI). In addition, there were typical cortical ribboning patterns in bilateral parieto-occipital and bilateral medial frontal regions in DWI. The electroencephalography (EEG) revealed nonspecific generalized slowing without any periodic sharp waves.

Based on the patient's symptoms and test results, I predict the top 2 disease causes as:

1. **Creutzfeldt-Jakob Disease (CJD)**: The patient's rapidly progressive dementia, parkinsonism, behavioral changes, and frontal release signs, along with the positive 14-3-3 protein in CSF and characteristic MRI findings (cortical ribboning patterns and hyperintensities in caudate, putamina, and thalami), are highly suggestive of CJD.
2. **Lewy Body Dementia (LBD)**: The patient's parkinsonism, cognitive decline, and behavioral changes, along with the presence of rigidity, bradykinesia, and resting tremor, are consistent with LBD. The patient's history of breast cancer and lack of response to tamoxifen may also be related to LBD.

Both diseases are neurodegenerative disorders that can present with similar symptoms, making differential diagnosis challenging. However, the presence of 14-3-3 protein in CSF and characteristic MRI findings in CJD make it a more likely diagnosis.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words:

69-year-old woman, a history of gait disturbance. Within the onset of gait difficulty, the family also noticed a symmetrical tremor in her hands and slowness of movements during daily activities accompanied by frequent falls.
About a month after the initiation of her symptoms, she reported a strange sensation inside her body without any objective phenomenon that was described as “chills inside her body.” Afterward, behavioral change became apparent in the form of delusion of persecution, changes in personality, and feelings of fear without reason. She became paranoid about others and had less confidence in close relatives.
A few months later, her gait worsened with the need for a walking aid and intensified tremors in both hands and her chin. Progressively she lost the ability to walk without help, and generalized myoclonic jerks appeared.
Notably, her past medical history included breast cancer diagnosed 2 years before this admission. She has undergone lumpectomy and chemoradiotherapy and, subsequently, oral tamoxifen. The follow-up had not shown any evidence of the relapse of the tumor.

After 8 months of initial presentation, the neurological examination revealed an awake and alert lady but not completely oriented to time and place. The Mini-Mental Status Examination (MMSE) score was 13 out of 30. Rigidity and bradykinesia were detected symmetrically on both sides. She had a resting tremor in both hands and her chin. The gait examination revealed a stooped posture with a short stepping gait and occasional freezing. Deep tendon reflexes were all symmetrically +1 to +2, and plantar reflexes were downward bilaterally. Although the sensory examination revealed no remarkable findings, the patient stated distal paresthesia of the upper limbs. Other positive findings in the examination were grasp reflex, utilization behavior, and the Myerson sign.

After admission, a comprehensive workup was performed with the clinical features of rapidly progressive dementia, parkinsonism, behavioral change, and frontal release signs. Blood and urine tests were normal, including electrolytes, liver, and kidney function tests, and level of vitamin B12. Tests for systemic vasculitis were all negative. Thyroid function tests and Anti-thyroid peroxidase antibody were in the normal range. According to the history of breast cancer, paraneoplastic and autoimmune antibodies in the blood and cerebrospinal fluid (CSF) were assessed, which showed no positive result. CSF analysis revealed no white blood cells and normal values for glucose and protein (39 mg/dL). The complementary tests revealed that the 14-3-3 protein was positive in CSF.

Based on the patient's symptoms and test results, I predict the top 2 disease causes as:

1. **Creutzfeldt-Jakob Disease (CJD)**: The patient's rapidly progressive dementia, parkinsonism, behavioral changes, and frontal release signs, along with the positive 14-3-3 protein in CSF, are highly suggestive of CJD. The disease is a rare, degenerative, and fatal brain disorder caused by an abnormal form of a protein called a prion.
2. **Lewy Body Dementia (LBD)**: The patient's symptoms of parkinsonism, cognitive decline, and behavioral changes, including delusions and hallucinations, are consistent with LBD. The presence of rigidity, bradykinesia, and resting tremors also supports this diagnosis. LBD is a progressive neurodegenerative disorder characterized by the presence of Lewy bodies in the brain.

Both diseases are neurodegenerative disorders that can present with similar symptoms, making a definitive diagnosis challenging. Further testing, such as imaging studies and genetic testing, may be necessary to confirm the diagnosis.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words:

69-year-old woman, a history of gait disturbance. Within the onset of gait difficulty, the family also noticed a symmetrical tremor in her hands and slowness of movements during daily activities accompanied by frequent falls.
About a month after the initiation of her symptoms, she reported a strange sensation inside her body without any objective phenomenon that was described as “chills inside her body.” Afterward, behavioral change became apparent in the form of delusion of persecution, changes in personality, and feelings of fear without reason. She became paranoid about others and had less confidence in close relatives.
A few months later, her gait worsened with the need for a walking aid and intensified tremors in both hands and her chin. Progressively she lost the ability to walk without help, and generalized myoclonic jerks appeared.
Notably, her past medical history included breast cancer diagnosed 2 years before this admission. She has undergone lumpectomy and chemoradiotherapy and, subsequently, oral tamoxifen. The follow-up had not shown any evidence of the relapse of the tumor.

Based on the patient's symptoms and medical history, I predict the top 2 disease causes as:

1. **Parkinson's disease**: The patient's symptoms of gait disturbance, symmetrical tremor, slowness of movements, and frequent falls are consistent with Parkinson's disease. The progression of symptoms, including worsening gait and intensified tremors, also supports this diagnosis.
2. **Lewy body dementia**: The patient's behavioral changes, including delusions of persecution, changes in personality, and feelings of fear without reason, are consistent with Lewy body dementia. The presence of myoclonic jerks and the patient's history of breast cancer and chemoradiotherapy may also contribute to the development of this condition.

Both conditions require further evaluation and testing to confirm the diagnosis.