developed difficulty with common tasks such as starting and driving her car. 5 days after the onset of her initial symptoms, she developed bizarre behaviour, disorientation, disturbed sleep, and incomprehensible speech. Her husband brought her to the hospital for further evaluation, where she was seen 7 days after symptom onset.

In the emergency room, she was found to be afebrile and haemodynamically stable with no abnormalities on routine blood tests, including a normal complete blood count and differential. The neurology service was consulted. In the neurological exam, the patient was unable to recall and name routine objects and had difficulty following commands. The motor exam showed normal strength with mildly increased tone, which was more noticeable in the right compared with the left extremities, and brisk deep tendon reflexessclerosing panencephalitis is related to wild-type measles infection, usually before age 2 years. Since the introduction of the measles vaccine, the disease has become exceedingly rare in North America. In Alberta, Canada, subacute sclerosing panencephalitis became reportable in 1983 and six cases were reported between 1983 and 1994. A monovalent live measles vaccination programme was introduced in Alberta in July, 1970, and the universal infant MMR programme was introduced in 1982.[@bib67] The MMR second dose campaign for children aged 4--6 years was introduced in 1996 and a catch-up programme (age 14--15 years) was introduced between 1997 and 1998.[@bib68] In India, an immunisation programme was introduced in 1978 as a WHO Expanded Programme of Immunization initiative.[@bib69] This programme gained momentum in 1985, and was expanded in a phased manner