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Garg RK, Suresh V, Suvirya S, Rizvi I, Kumar N, Pandey S. Clinical features, pathogenesis, pathology, neuroimaging, clinical course and outcome of measles inclusion-body encephalitis: a systematic review of published case reports and case series. Neurol Sci 2024; 45:3069-3091. [PMID: 38512528 DOI: 10.1007/s10072-024-07480-1] [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] [Received: 02/12/2024] [Accepted: 03/16/2024] [Indexed: 03/23/2024]
Abstract
Measles inclusion-body encephalitis (MIBE) is rare, with insights largely from case studies. We systematically analyzed subacute Sclerosing Panencephalitis (SSPE) cases in immunocompromised patients, identifying distinctive clinical and neuroimaging features. These findings could facilitate MIBE diagnosis without the need for brain biopsies. Our systematic review on MIBE and HIV-related SSPE adhered to PRISMA guidelines and was registered with PROSPERO. We searched multiple databases and followed a detailed inclusion process with independent reviews and quality assessment. Data on patient demographics, clinical features, and outcomes were compiled. A review of 39 studies on 49 MIBE patients and 8 reports on HIV-positive SSPE patients was conducted. Acute lymphoblastic leukemia, HIV, organ transplants, and malignancies were common precursors to MIBE. Perinatal HIV was prevalent among SSPE cases. Seizures were the primary symptom in MIBE, often drug-resistant and progressing to status epilepticus or epilepsia partialis continua, whereas periodic myoclonus was universal in SSPE. Neuroimaging showed distinct patterns for each group, and histopathology confirmed measles virus presence in 39% of MIBE cases. MIBE patients typically progressed to coma and death. In conclusion, MIBE and SSPE in HIV-infected patients present with distinct clinical pictures but identical brain pathological abnormalities.
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Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George's Medical University, Lucknow, 226003, India.
| | - Vinay Suresh
- Department of Neurology, King George's Medical University, Lucknow, 226003, India
- Department of Dermatology, Venereology And Leprosy, King George's Medical University, Lucknow, 226003, India
| | - Swastika Suvirya
- Department of Neurology, King George's Medical University, Lucknow, 226003, India
| | - Imran Rizvi
- Department of Neurology, King George's Medical University, Lucknow, 226003, India
| | - Neeraj Kumar
- Department of Neurology, King George's Medical University, Lucknow, 226003, India
| | - Shweta Pandey
- Department of Neurology, King George's Medical University, Lucknow, 226003, India
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Vidhale TA, Gupta HR, Prafulla Jaya R, Pustake M. Fulminant subacute sclerosing panencephalitis (SSPE) presented with acute hemiparesis in a 13-year-old girl with perinatally acquired HIV infection. BMJ Case Rep 2021; 14:e241205. [PMID: 34518172 PMCID: PMC8438743 DOI: 10.1136/bcr-2020-241205] [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] [Accepted: 08/22/2021] [Indexed: 11/03/2022] Open
Abstract
A 13-year-old girl with perinatally acquired HIV infection was admitted to us with acute onset, right-sided hemiparesis of 30 days duration and right-sided myoclonic jerks of 2 days duration affecting the face, upper and lower limbs. On examination, she exhibited increased tone and a pyramidal pattern of weakness in her right upper and lower limbs, along with spontaneous multifocal myoclonic jerks in the affected area. IgG levels in the serum and cerebrospinal fluid for measles were significantly elevated. Brain MRI depicted T2-weighted-hyperintensities in the subcortical white matter. The electroencephalogram demonstrated evidence of lateralised long interval periodic discharges. This patient had no past behavioural problems or poor academic performance. This case underlines the fact that, though subacute sclerosing panencephalitis (SSPE) is a chronic disease, a rare fulminant form of SSPE might develop acutely and atypically, with an increased proclivity for HIV-infected patients.
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Affiliation(s)
- Tushar Ashok Vidhale
- General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Hemant R Gupta
- General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Rohan Prafulla Jaya
- Department of Radiology, BGS Global Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Manas Pustake
- General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
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Lytvyn H, Basa N, Stasiv M, Troyanovska O, Dorosh O. Difficulties in diagnosing of measles inclusion body encephalitis in a child with acute lymphoblastic leukemia. IDCases 2020; 21:e00877. [PMID: 32637321 PMCID: PMC7327900 DOI: 10.1016/j.idcr.2020.e00877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/09/2020] [Accepted: 06/15/2020] [Indexed: 11/26/2022] Open
Abstract
Report of measles inclusion body encephalitis in child with leukemia. It is necessary to determine antibodies to measles virus in the cerebrospinal fluid. We found intrathecal synthesis of IgG antibodies to measles virus. The disease had a dramatic course and ended in death.
The measles epidemic was observed in Ukraine during 20172019. According to WHO, in Ukraine there was registered the highest number of measles cases in Europe during that period [8]. Measles is characterized by an acute course with fever, maculopapular rash, cough, conjunctivitis and can lead to central nervous system complications (encephalitis, encephalomyelitis) and bronchopulmonary system complications (laryngotracheobronchitis, bronchiolitis, pneumonia). In immunocompetent patients, viremia ends after the end of clinical signs, in contrast to immunosuppressed individuals, who could develop viremia from one month up to a year. We have described a case of measles inclusion body encephalitis (MIBE) or subacute measles encephalitis (SME) in an unvaccinated child with an acute lymphoblastic leukemia (ALL). The diagnosis was confirmed by the synthesis of IgG antibodies to the measles virus in the cerebrospinal fluid and by the MRI results. The disease had a dramatic course and ended in death.
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Affiliation(s)
- Halyna Lytvyn
- Department of Pediatric Infectious Diseases, Danylo Halytsky Lviv National Medical University, Communal Noncommercial Enterprise of Lviv Regional council "Lviv Regional Infectious Diseases Hospital", Lviv, Ukraine
| | - Natella Basa
- Department of Pediatric Infectious Diseases, Danylo Halytsky Lviv National Medical University, Communal Noncommercial Enterprise of Lviv Regional council "Lviv Regional Infectious Diseases Hospital", Lviv, Ukraine
| | - Mariia Stasiv
- Department of Pediatric Infectious Diseases, Danylo Halytsky Lviv National Medical University, Communal Noncommercial Enterprise of Lviv Regional council "Lviv Regional Infectious Diseases Hospital", Lviv, Ukraine
| | - Olga Troyanovska
- Department of Pediatrics, Danylo Halytsky Lviv National Medical University, Communal Noncommercial Enterprise of Lviv Regional Council "Western Ukrainian Specialized Children's Medical Centre", Lviv, Ukraine
| | - Olga Dorosh
- Department of pediatrics and neonatology FPGE, Danylo Halytsky Lviv National Medical University, Communal noncommercial enterprise of Lviv regional council "Western Ukrainian Specialized Children's Medical Centre", Lviv, Ukraine
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Khilari ML, Sharma PK. Clinical conundrum: status epilepticus culminating into acute dystonia myoclonus. BMJ Case Rep 2020; 13:13/2/e233397. [DOI: 10.1136/bcr-2019-233397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 7-year-old child who suffered from symptomatic focal epilepsy as a sequel to perinatal hypoxia used to have frequent seizures. This time she developed prolonged status epilepticus lasting for over 5 hours. She received a treatment in the form of intravenous midazolam and reinitiation of sodium valproate and clobazam that were discontinued previously. Seizures were controlled over a couple of hours, but she remained unresponsive. Later, she developed acute onset dystonia (day 3 post-status epilepticus) and also myoclonic jerks. She presented to us after 3 weeks of onset of these complaints and we considered hypoxic encephalopathy resulting from prolonged status epilepticus or acute encephalitis or non-convulsive status epilepticus. However, acute onset dystonia and periodicity of myoclonic jerks were pointers against it, and on evaluation, she was diagnosed with atypical fulminant subacute sclerosing panencephalitis (SSPE). Knowing the atypical presentations of SSPE is important in planning management and prognostication.
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Kandadai RM, Yada P, Uppin MS, Jabeen SA, Cherian A, Kanikannan MA, Borgohain R, Challa S. Fulminant subacute sclerosing panencephalitis presenting with acute ataxia and hemiparesis in a 15-year-old boy. J Clin Neurol 2014; 10:354-7. [PMID: 25324886 PMCID: PMC4198718 DOI: 10.3988/jcn.2014.10.4.354] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 06/12/2013] [Accepted: 06/15/2013] [Indexed: 11/17/2022] Open
Abstract
Background Subacute sclerosing panencephalitis (SSPE) is a delayed and fatal manifestation of measles infection. Fulminant SSPE is a rare presentation in which the disease progresses to death over a period of 6 months. The clinical features are atypical and can be misleading. Case Report We report herein a teenage boy who presented with acute-onset gait ataxia followed by right hemiparesis that evolved over 1 month, with left-hemispheric, delta-range slowing on the electroencephalogram (EEG). Magnetic resonance imaging disclosed multiple white-matter hyperintensities, suggesting a diagnosis of acute disseminated encephalomyelitis. He received intravenous steroids, and within 4 days of hospital admission he developed unilateral slow myoclonic jerks. Repeat EEG revealed Rademecker complexes, pathognomonic of SSPE, and an elevated titer of IgG antimeasles antibodies was detected in his cerebrospinal fluid. The disease progressed rapidly and the patient succumbed within 15 days of hospitalization. The diagnosis of SSPE was confirmed by autopsy. Conclusions This case illustrates the difficulty of recognizing fulminant SSPE when it manifests with asymmetric clinical and EEG abnormalities.
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Affiliation(s)
| | - Praveen Yada
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Megha S Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Shaik Afshan Jabeen
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Ajith Cherian
- Department of Neurology, Medical College Hospital, Trivandrum, Kerala, India
| | | | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Sundaram Challa
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, India
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Shyam babu C, Satishchandra P, Mahadevan A, Pillai Shibu V, Ravishankar S, Sidappa N, Udaykumar R, Ravi V, Shankar SK. Usefulness of stereotactic biopsy and neuroimaging in management of HIV-1 Clade C associated focal brain lesions with special focus on cerebral toxoplasmosis. Clin Neurol Neurosurg 2012; 115:995-1002. [PMID: 23153789 DOI: 10.1016/j.clineuro.2012.10.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 08/23/2012] [Accepted: 10/16/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Focal brain lesions (FBL) in HIV/AIDS frequently pose a diagnostic dilemma as the etiology varies from infective (tuberculoma, toxoplasmosis and tuberculous abscesses) to neoplastic lesions like lymphoma. For determining etiology, advanced neuroimaging techniques, serological and molecular biological tests have been evolved with varying sensitivities/specificities. Stereotactic biopsy (STB) of the lesions is reserved for lesions unresponsive to appropriate therapy. OBJECTIVE AND METHODS In this study, the diagnostic yield of neuroimaging [cranial CT (n=25), MRI (n=24), and Th201/99Tc SPECT scan (n=18)] is compared with histopathological diagnosis obtained by STB (n=21) or autopsy (n=4) in 25 HIV-1 subtype C seropositive individuals with FBL identified by neuroimaging with special reference to cerebral toxoplasmosis in an eighteen month study period (2006-2007). RESULTS AND CONCLUSION Cerebral toxoplasmosis was the most frequent cause of FBL (21/25, 84%), followed by one case each of tuberculoma, progressive multifocal leukoencephalopathy (PML), primary central nervous system lymphoma (PCNSL) and measles inclusion body encephalitis (MIBE), the last two diagnosed at autopsy. Of the 21 cases of cerebral toxoplasmosis, definitive diagnosis with histopathological confirmation was available in 14/21 (66.6%), with indirect evidence suggesting probable toxoplasmosis in seven, all of whom responded to antitoxoplasma therapy. CT and MRI had comparable specificities (75%), while MRI had marginally higher sensitivity (85% versus 80.9%) in detecting multiple lesions. The positive predictive value of both CT and MRI was identical (94.4%), suggesting that CT maybe a cost effective screening tool in resource restricted settings, for evaluating FBL. Sensitivity of 99Tc SPECT scan for diagnosing inflammatory lesions was 75% but failed to differentiate PCNSL from toxoplasmosis. This study is the first of its kind from India analyzing FBL with specific focus on cerebral toxoplasmosis in the setting of HIV-1 subtype C.
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Affiliation(s)
- C Shyam babu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
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