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Karthik V, Koshy KG, Asok A, Chettiar S. Subacute sclerosing panencephalitis presenting as severe depression in an adult. BMJ Case Rep 2024; 17:e259111. [PMID: 38697683 PMCID: PMC11085698 DOI: 10.1136/bcr-2023-259111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a fatal disorder that occurs as a rare complication of childhood measles. Symptoms typically manifest between the ages of 5 and 15. While the incidence of SSPE is declining globally, it is still prevalent in regions where measles remains common and vaccination rates are low due to poverty and lack of health education. Diagnosing SSPE can be challenging, particularly when patients exhibit unusual symptoms. A thorough clinical evaluation, including vaccination history, physical examination, electroencephalogram (EEG) and Cerebrospinal fluid (CSF) analysis, can help in making a diagnosis. We present the case of a young woman in her early 20s who initially experienced depressive symptoms, followed by myoclonus, dementia and visual impairment. The patient was ultimately diagnosed with SSPE based on characteristic EEG findings, neuroimaging results, CSF analysis and elevated serum measles antibody levels.
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Affiliation(s)
- Vijayakumar Karthik
- Endocrinology, Government Medical College Thiruvananthapuram, Thiruvananthapuram, India
| | - Kiren George Koshy
- Government Medical College and Hospital, Thiruvananthapuram, Kerala, India
| | - Arsha Asok
- Government Medical College and Hospital, Trivandrum, Kerala, India
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Mogavero MP, Salemi M, Lanza G, Rinaldi A, Marchese G, Ravo M, Salluzzo MG, Antoci A, DelRosso LM, Bruni O, Ferini-Strambi L, Ferri R. Unveiling the pathophysiology of restless legs syndrome through transcriptome analysis. iScience 2024; 27:109568. [PMID: 38617564 PMCID: PMC11015462 DOI: 10.1016/j.isci.2024.109568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/22/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Abstract
The aim of this study was to analyze signaling pathways associated with differentially expressed messenger RNAs in people with restless legs syndrome (RLS). Seventeen RLS patients and 18 controls were enrolled. Coding RNA expression profiling of 12,857 gene transcripts by next-generation sequencing was performed. Enrichment analysis by pathfindR tool was carried-out, with p-adjusted ≤0.001 and fold-change ≥2.5. Nine main different network groups were significantly dysregulated in RLS: infections, inflammation, immunology, neurodegeneration, cancer, neurotransmission and biological, blood and metabolic mechanisms. Genetic predisposition plays a key role in RLS and evidence indicates its inflammatory nature; the high involvement of mainly neurotropic viruses and the TORCH complex might trigger inflammatory/immune reactions in genetically predisposed subjects and activate a series of biological pathways-especially IL-17, receptor potential channels, nuclear factor kappa-light-chain-enhancer of activated B cells, NOD-like receptor, mitogen-activated protein kinase, p53, mitophagy, and ferroptosis-involved in neurotransmitter mechanisms, synaptic plasticity, axon guidance, neurodegeneration, carcinogenesis, and metabolism.
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Affiliation(s)
- Maria P. Mogavero
- Vita-Salute San Raffaele University, 20132 Milan, Italy
- San Raffaele Scientific Institute, Division of Neuroscience, Sleep Disorders Center, 20127 Milan, Italy
| | | | - Giuseppe Lanza
- Oasi Research Institute-IRCCS, 94018 Troina, Italy
- University of Catania, Department of Surgery and Medical-Surgical Specialties, 95123 Catania, Italy
| | - Antonio Rinaldi
- Genomix4Life Srl, 84081 Baronissi, Italy
- Genome Research Center for Health-CRGS, 84081 Baronissi, Italy
| | - Giovanna Marchese
- Genomix4Life Srl, 84081 Baronissi, Italy
- Genome Research Center for Health-CRGS, 84081 Baronissi, Italy
| | - Maria Ravo
- Genomix4Life Srl, 84081 Baronissi, Italy
- Genome Research Center for Health-CRGS, 84081 Baronissi, Italy
| | | | | | | | - Oliviero Bruni
- Sapienza University of Rome, Developmental and Social Psychology, 00185 Rome, Italy
| | - Luigi Ferini-Strambi
- Vita-Salute San Raffaele University, 20132 Milan, Italy
- San Raffaele Scientific Institute, Division of Neuroscience, Sleep Disorders Center, 20127 Milan, Italy
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Mondal R, Deb S, Mahata M, Saha S, Lahiri D, Benito-León J. Subacute Sclerosing Panencephalitis in a 63-Year-Old Woman Presenting as Generalized Choreoathetosis. Neurohospitalist 2023; 13:381-393. [PMID: 37701261 PMCID: PMC10494821 DOI: 10.1177/19418744231177105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
The persistence of measles virus infection in childhood and early adolescence can rarely lead to a fatal progressive neurodegenerative disorder known as subacute sclerosing panencephalitis (SSPE), characterized by behavioral disturbances and intellectual disability followed by myoclonic jerks and occasional negative myoclonus. Movement disorders are rarely presenting manifestations in SSPE. We herein report a 63-year-old woman with generalized choreoathetosis as the presenting manifestation of stage-I SSPE. Our case was atypical for the patient's age and clinical presentation with generalized choreoathetosis and bilateral putaminal and caudate nucleus signal hyperintensity. Though highly uncommon, neurologists should keep SSPE as a differential diagnosis among patients with movement disorders. Measles-endemic countries should be more vigilant to the atypical and rare presentations of SSPE, such as generalized choreoathetosis.
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Affiliation(s)
- Ritwick Mondal
- Department of Clinical Pharmacology and Therapeutic Medicine, IPGMER and SSKM Hospital, Kolkata, India
| | - Shramana Deb
- Department of Neuroscience, S.N.Pradhan Centre for Neuroscience, Kolkata, India
| | - Manoj Mahata
- Department of Interventional Neurology, Bellevue Clinic, Kolkata, India
| | - Somesh Saha
- Department of Critical Care Medicine, Bellevue clinic, Kolkata, India
| | - Durjoy Lahiri
- Department of Cognitive Neurology, Baycrest Health Sciences and Rotman Research Institute, University of Toronto, Canada, India
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
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Structured Imaging Approach for Viral Encephalitis. Neuroimaging Clin N Am 2023; 33:43-56. [DOI: 10.1016/j.nic.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sinha R, Singh S, Balamurugan N, Pandey A. Myoclonic-Atonic Epilepsy Masquerading as Subacute Sclerosing Panencephalitis: A Clinical Conundrum. ANNALS OF CHILD NEUROLOGY 2022. [DOI: 10.26815/acn.2022.00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Magnetic resonance imaging patterns of subacute sclerosing panencephalitis may mimic metabolic disorders: clinical, electroencephalographic and imaging features of six cases. Acta Neurol Belg 2021; 121:955-965. [PMID: 32809122 DOI: 10.1007/s13760-020-01469-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
Subacute sclerosing panencephalitis is a rare, devastating neurodegenerative encephalitis whose diagnosis and therapy are still in question. Atypical clinical presentation and heterogeneity of neuroimaging findings that have been initially confused with metabolic disorders have hampered early diagnosis. To describe a series of patients with subacute sclerosing panencephalitis with imaging findings mimicking metabolic disorders. A total of six patients with subacute sclerosing panencephalitis were diagnosed from January 2012 to December 2016 in whom a metabolic disorder was suspected on initial clinical and MRI findings. Detailed laboratory investigation was performed in all patients. All patients presented with atypical neurologic manifestations, including dystonia, syncopal attacks, involuntary limb movements, meaningless speech and ataxia. Magnetic resonance imaging abnormalities included bilateral putaminal, bilateral posterior periventricular white matter and diffuse or splenial corpus callosum involvement which are particularly unusual in SSPE and mostly observed in metabolic disorders. All patients had elevated cerebrospinal fluid Ig G measles antibodies. The diagnosis of subacute sclerosing panencephalitis through clinical and imaging features can be considerably challenging. It is crucial to differentiate it from metabolic disorders, since the management and clinical outcome are different.
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Kathuria H, Prabhat N, Shree R, Singh R. Subacute sclerosing panencephalitis and brain stem involvement: a rare combination. BMJ Case Rep 2021; 14:e236538. [PMID: 33542002 PMCID: PMC7868203 DOI: 10.1136/bcr-2020-236538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 02/06/2023] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a progressive lethal neurological inflammatory disease due to persistent, wild measles virus infection in the central nervous system that is seen most frequently in children and young adolescents. Atypical presentations are seen in up to 10% of cases. Most frequently and severely affected region in the brain is the parieto-occipital region of the brain. Less commonly involved organs are the cerebellum, basal ganglia and corpus callosum. Brainstem involvement is rare and usually occurs when other areas of brain are involved along with it. Here, we describe an unusual male patient of 15 years age, having SSPE with MRI of brain showing extensive involvement of brainstem with no significant involvement of other cortical structures of the brain. It is very rarely described in SSPE, but one should be vigilant about such involvement of brainstem and cerebellum, and SSPE should not be missed when brainstem hyperintensities are seen in MRI brain with or without other region of the brain to avoid misdiagnosis.
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Affiliation(s)
- Heena Kathuria
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Prabhat
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Shree
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajveer Singh
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Pandey S, Shukla T, Mishra A. The Spectrum of Repetitive Behaviors Associated With Subacute Sclerosing Panencephalitis. Mov Disord 2020; 36:497-503. [PMID: 32986918 DOI: 10.1002/mds.28323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/30/2020] [Accepted: 09/03/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Repetitive behaviors refer to a broad class of responses ranging from stereotypic body movements to impulsive/compulsive behaviors. They may be associated with neurological disorders. METHODS This is a case series of six subacute sclerosing panencephalitis (SSPE) patients who presented with a wide spectrum of repetitive motor behaviors and vocalizations. RESULTS Repetitive motor behaviors involved the upper limbs in all patients and lower limbs in 3 patients. The repetitive movements in the upper limbs were clapping, finger-clicking, hand rubbing, flailing, and dystonic posturing. In the lower limbs, the repetitive movements were rubbing with the heel, pelvic thrusting with flexion extension of the leg, and foot tapping. The spectrum of vocalizations included palilalia, whistling, grunting with spitting, and pathological crying. Repetitive behaviors were the presenting features in 2 patients. CONCLUSIONS This case series expands the spectrum of repetitive behaviors seen in neurological disorders associated with brain infections. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Tanvi Shukla
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Anumeha Mishra
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
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Mekki M, Eley B, Hardie D, Wilmshurst JM. Subacute sclerosing panencephalitis: clinical phenotype, epidemiology, and preventive interventions. Dev Med Child Neurol 2019; 61:1139-1144. [PMID: 30680706 DOI: 10.1111/dmcn.14166] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/28/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a preventable condition reported in 6.5 to 11 per 100 000 cases of measles, and highest in children who contracted measles infection when they were less than 5 years of age. Children residing in areas with poor vaccination coverage and high prevalence of human immunodeficiency virus are at increased risk of developing SSPE. SSPE is life-threatening in most affected children. This report documents current data relating to the clinical phenotype, epidemiology, and understanding of SSPE, inclusive of preventive interventions. While improvements in disease progression with immunomodulation may occur, overall there is no cure. Most therapies focus on supportive needs. Seizures and abnormal movements may respond to carbamazepine. Many countries advocate policies to enhance vaccination coverage. Effective preventive health care programmes, assurance of parental perceptions, and crisis support for unprecedented events obstructing effective primary health care are needed. Until measles is eradicated worldwide, children in all regions remain at risk. WHAT THIS PAPER ADDS: Measles contracted under 5 years of age has highest risk of developing subacute sclerosing panencephalitis (SSPE). Children with, or exposed to, human immunodeficiency virus infection, who contract measles may be at increased risk of SSPE.
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Affiliation(s)
- Mohammed Mekki
- Paediatric Neurology Division, Department of Paediatrics and Child Health, Neuroscience Institute, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Diana Hardie
- Division of Medical Virology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | - Jo M Wilmshurst
- Paediatric Neurology Division, Department of Paediatrics and Child Health, Neuroscience Institute, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Jayaraman K, Rangasami R, Chandrasekharan A. Magnetic Resonance Imaging Findings in Viral Encephalitis: A Pictorial Essay. J Neurosci Rural Pract 2019; 9:556-560. [PMID: 30271050 PMCID: PMC6126294 DOI: 10.4103/jnrp.jnrp_120_18] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Viral encephalitis by definition is the result of human virus affecting the brain and sparing the meninges. The other nervous system manifestations are meningitis, meningoencephalitis, encephalomyelitis, and encephalomyeloradiculitis. Encephalitis can involve any age group from children to old people. The severity of the disease depends on the viral agent and the host immune system. The patient can present with fever, headache, seizure, neurological deficit, or altered sensorium. Laboratory investigations, imaging, and cerebrospinal fluid analysis are crucial in the diagnosis of encephalitis. Magnetic resonance imaging (MRI) findings may be nonspecific or specific and plays a major role in the diagnosis of encephalitis and predicting the possible cause. This pictorial essay reviews the MRI findings of common types of viral encephalitis.
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Affiliation(s)
- Kalaivani Jayaraman
- Department of Radiology and Imaging Sciences, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Rajeswaran Rangasami
- Department of Radiology and Imaging Sciences, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Anupama Chandrasekharan
- Department of Radiology and Imaging Sciences, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Garg RK, Mahadevan A, Malhotra HS, Rizvi I, Kumar N, Uniyal R. Subacute sclerosing panencephalitis. Rev Med Virol 2019; 29:e2058. [PMID: 31237061 DOI: 10.1002/rmv.2058] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/05/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a slowly progressive brain disorder caused by mutant measles virus. SSPE affects younger age groups. SSPE incidence is proportional to that of measles. High-income countries have seen substantial decline in SSPE incidence following universal vaccination against measles. SSPE virus differs from wild measles virus. Measles virus genome recovered from the autopsied brain tissues demonstrates clustered mutations in virus genome particularly in the M gene. These mutations destroy the structure and functioning of the encoded proteins. Complete infectious virus particle has rarely been recovered from the brain. Human neurons lack required receptor for entry of measles virus inside the neurons. Recent in vitro studies suggest that mutations in F protein confer hyperfusogenic properties to measles virus facilitating transneuronal viral spread. The inflammatory response in the brain leads to extensive tissue damage. Clinically, SSPE is characterized by florid panencephalitis. Clinically, SSPE is characterized by cognitive decline, periodic myoclonus, gait abnormalities, vision loss, and ultimately to a vegetative state. Chorioretinitis is a common ocular abnormality. Electroencephalography (EEG) shows characteristic periodic discharges. Neuroimaging demonstrates periventricular white matter signal abnormalities. In advanced stages, there is marked cerebral atrophy. Definitive diagnosis requires demonstration of elevated measles antibody titers in cerebrospinal fluid (CSF). Many drugs have been used to stabilize the course of the disease but without evidence from randomized clinical trials. Six percent of patients may experience prolonged spontaneous remission. Fusion inhibitor peptide may, in the future, be exploited to treat SSPE. A universal vaccination against measles is the only proven way to tackle this menace currently.
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Affiliation(s)
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Hardeep Singh Malhotra
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Imran Rizvi
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Neeraj Kumar
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ravi Uniyal
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Tandra HV, Roy PS, Sharma R, Bhatia V, Saini AG. Subacute Sclerosing Panencephalitis Presenting as Choreoathetosis and Basal Ganglia Hyperintensities. Neurohospitalist 2018; 9:26-29. [PMID: 30671161 DOI: 10.1177/1941874418776902] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Subacute sclerosing panencephalitis is a devastating neurodegenerative disorder characterized by cognitive and memory deterioration, personality changes, behavior abnormalities, and a steady motor decline. Extrapyramidal manifestations are commonly seen in the advanced stage of the disease. We discuss a 10-year-old boy with subacute sclerosing panencephalitis presenting with generalized choreoathetosis, myoclonus, and cognitive decline. He had not been immunized for measles. His elder sister had a viral exanthematous illness 4 years ago. Magnetic resonance imaging revealed bilateral, asymmetric putaminal hyperintensities. A diagnosis of subacute sclerosing panencephalitis was confirmed by periodic complexes in the electroencephalograph and elevated antimeasles antibody titers in the blood and cerebrospinal fluid (1:625). Our case highlights that atypical clinical and radiological features of subacute sclerosing panencephalitis should always be borne in mind in children from endemic areas. Generalized choreoathetosis and bilateral putaminal involvement in the index case add to the spectrum of atypical presentations of subacute sclerosing panencephalitis in children.
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Affiliation(s)
- Harish Varma Tandra
- Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pritam Singha Roy
- Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Sharma
- Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Bhatia
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Gahlot Saini
- Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Subacute Sclerosing Panencephalitis of the Brainstem as a Clinical Entity. Med Sci (Basel) 2017; 5:medsci5040026. [PMID: 29112137 PMCID: PMC5753655 DOI: 10.3390/medsci5040026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/30/2017] [Accepted: 11/03/2017] [Indexed: 12/16/2022] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a rare progressive neurological disorder of early adolescence caused by persistent infection of the measles virus, which remains prevalent worldwide despite an effective vaccine. SSPE is a devastating disease with a characteristic clinical course in subcortical white matter; however, atypical presentations of brainstem involvement may be seen in rare cases. This review summarizes reports to date on brainstem involvement in SSPE, including the clinical course of disease, neuroimaging presentations, and guidelines for treatment. A comprehensive literature search was performed for English-language publications with keywords “subacute sclerosing panencephalitis” and “brainstem” using the National Library of Medicine PubMed database (March 1981–September 2017). Eleven articles focusing on SSPE of the brainstem were included. Predominant brainstem involvement remains uncharacteristic of SSPE, which may lead to misdiagnosis and poor outcome. A number of case reports have demonstrated brainstem involvement associated with other intracranial lesions commonly presenting in later SSPE stages (III and IV). However, brainstem lesions can appear in all stages, independent of higher cortical structures. The varied clinical presentations complicate diagnosis from a neuroimaging perspective. SSPE of the brainstem is a rare but important clinical entity. It may present like canonical SSPE or with unique clinical features such as absence seizures and pronounced ataxia. While SSPE generally progresses to the brainstem, it can also begin with a primary focus of infection in the brainstem. Awareness of varied SSPE presentations can aid in early diagnosis as well as guide management and treatment.
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Almeida KJ, Brucki SMD, Duarte MIS, Pasqualucci CAG, Rosemberg S, Nitrini R. Basal ganglia lesions in subacute sclerosing panencephalitis. Dement Neuropsychol 2012; 6:286-289. [PMID: 29213810 PMCID: PMC5619342 DOI: 10.1590/s1980-57642012dn06040014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The parieto-occipital region of the brain is the most frequently and severely
affected in subacute sclerosing panencephalitis (SSPE). The basal ganglia,
cerebellum and corpus callosum are less commonly involved. We describe a patient
with SSPE confirmed by neuropathology based on brain magnetic resonance imaging
showing extensive basal ganglia involvement and no significant involvement of
other cortical structures. Though rarely described in SSPE, clinicians should be
aware of this involvement. SSPE should be kept in mind when changes in basal
ganglia signal are seen on brain magnetic resonance imaging with or without
involvement of other regions of the human brain to avoid erroneous etiological
diagnosis of other pathologies causing rapidly progressive dementia.
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Affiliation(s)
- Kelson James Almeida
- MD, Behavioral and Cognitive Neurology Unit and Cognitive Disorders Reference Center (CEREDIC), Department of Neurology, São Paulo SP, Brazil
| | - Sonia Maria Dozzi Brucki
- MD, Behavioral and Cognitive Neurology Unit and Cognitive Disorders Reference Center (CEREDIC), Department of Neurology, São Paulo SP, Brazil
| | | | | | - Sérgio Rosemberg
- Department of Pathology, School of Medicine of the University of São Paulo (FMUSP) São Paulo SP, Brazil
| | - Ricardo Nitrini
- MD, Behavioral and Cognitive Neurology Unit and Cognitive Disorders Reference Center (CEREDIC), Department of Neurology, São Paulo SP, Brazil
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