Subacute sclerosing panencephalitis with bilateral inferior collicular hyperintensity on magnetic resonance imaging brain
An 8-year-old boy presented with behavioral changes, poor school performance, speech deterioration, recurrent falls, urinary incontinence and, later, fluctuating sensorium and myoclonic jerks evolving over 2 months to a bed bound state with altered sensorium (Clinical stage III). In addition, he had bilateral pyramidal signs. He had history suggestive of measles 3 years back. MRI brain showed T2-weighted hyperintensities in the subcortical areas of the left occipital lobe and brachium of the inferior colliculus on both sides. These abnormal areas showed increased signal intensity of diffusion-weighted images (DWI). Other areas were normal []. EEG showed synchronous, periodic bursts of sharp and slow wave complexes bilaterally, lasting for a period of 3–4 s and occurring at regular intervals of about 6 s. Cerebrospinal fluid (CSF) showed 2 cells/cumm (all lymphocytes), 23 mg% proteins and 62 mg% glucose, without atypical cells. CSF polymerase chain reaction (for Herpes, EBV, Cytomegalo, Varicella and Adeno viruses) was negative. CSF measles serology was significantly positive (serum/CSF measles IgG titer ratio was 20, ratio of <64 is considered significant). Overall features were suggestive of fulminant SSPE, but with atypical brain imaging features.