Subacute sclerosing panencephalitis. A clinical and biological reappraisal

Subacute sclerosing panencephalitis and acquired immunodeficiency syndrome: role of electroencephalography and magnetic resonance imaging

Subacute sclerosing panencephalitis (SSPE) had largely disappeared from the United States because of nearly universal measles vaccination, but it has reemerged in children infected with human immunodeficiency virus (HIV). Two children with SSPE are described. The first was HIV positive and presented with seizures and encephalopathy at the age of 21 months. The second developed myoclonus and dementia at age 4 years; she was not infected with HIV, but her mother had acquired immunodeficiency syndrome. Magnetic resonance imaging findings were nonspecific and could have been compatible with HIV encephalopathy. Electroencephalography was characteristic of SSPE, showing high-voltage, periodic slow-wave complexes and background slowing. The diagnosis of SSPE was confirmed by brain biopsy or high measles antibody titers in the cerebrospinal fluid.

Subacute sclerosing panencephalitis presenting as transient homonymous hemianopia

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An acute variant of subacute sclerosing panencephalitis: an autopsy case report

An acute variant of subacute sclerosing panencephalitis (SSPE) was described in a 5-year-old boy who showed rapid progression of coma within 14 days of right hemiplegia. He had measles at 3 years of age. The diagnosis of SSPE was based on the following findings: high anti-measles antibody titer in the serum and in the spinal fluid, periodic complex of EEG, and typical pathological changes of the brain. Treatment with transfer factor failed to improve the worsening clinical course. It is suggested that SSPE should be considered in the differential diagnosis of acute fulminating encephalitides or intracranial vascular lesions.

Subacute sclerosing panencephalitis

A 17-year-old white woman had an acute left maculopathy of unknown etiology. She was in excellent health and had only had rubeola at 3 years of age. Hruby lens examination of the left eye, visual acuity of 6/60 (20/200), revealed a normal vitreous, macular edema, intraretinal hemorrhage, and cotton-wool exudates. Xenon photo-coagulation was performed on the left eye. The visual acuity remained 6/60 (20/200) with drying of the retina. The patient remained in excellent health until 22 months after the initial ocular problem when she developed a left homonymous hemianopia. Then her mind deteriorated, and she became demented. We diagnosed subacute sclerosing panencephalitis after finding an increased spinal fluid gamma globulin, raised serum and spinal fluid titers of measles antibodies, and an electroencephalogram pathognomonic for this condition.

Atypical subacute sclerosing panencephalitis

An unusual case of panencephalitis in a 4-year-old Japanese boy, with onset at three months after measles infection and rapid progression to a comatose state in approximately one month, is described. A rapid rise in serum measles antibody titre after the onset of the symptoms, and the appearance of various abnormal antibodies in the serum, were noted. Pathologically, the brain showed sclerosing polio- and leucoencephalitis with diffuse gliosis and sporadic intranuclear inclusions. The process is suggested to be intermediate or transitional between acute measles encephalitis and SSPE.