Affiliations: Department of Neurology, National Institute of Mental
Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India | Department of Neuroimaging and Interventional
Radiology, National Institute of Mental Health and Neurosciences, Bangalore,
India | Department of Neurovirology, National Institute of
Mental Health and Neurosciences, Bangalore, India
Note: [] Correspondence: Dr. Sanjib Sinha, M.D., National Institute of Mental Health and Neurosciences (NIMHANS), 560
029, Bangalore, India. Tel.: +91 80 26995150; Fax: +91 80 26564830; E-mail:
[email protected]
Abstract: Reports of magnetic resonance imaging (MRI) findings in subacute
sclerosing panencephalitis (SSPE) with clinical and electroencephalography
(EEG) correlation are few. To describe the MRI features of SSPE and correlate
with its clinical features and EEG. Clinical, MRI and EEG data of 33 patients
(male/female 19/14; age: 11.4 ± 5.3 yr) were reviewed. All patients had
raised IgG anti-measles antibody (⩾ 1:625) in cerebrospinal fluid. Their
clinical features were myoclonus (100%), seizures (42%), visual disturbances
(18%), pyramidal signs (30%), extrapyramidal symptoms (27%), and cognitive
impairment (79%) and behavioral changes (21%). EEGs were universally abnormal:
diffuse slowing of background activity-all; periodic complexes-27
(symmetrical): High voltage delta waves (55%) and sharp & slow wave
discharges (45%). MRI findings included – normal (9%), cerebral atrophy
(78%), white matter (76%) and basal ganglia (6%) changes. Restricted diffusion
in periventricular/subcortical region was noted in 4/23 patients (stage 2).
Magnetic resonance spectroscopy showed decreased N-acetyl aspartate peaks and
elevated choline peaks in 75% and lactate peak in 25% (stage 3) of patients.
Correlation of background delta activity among patients with MRI signal
abnormalities and those without any signal change was noted (P=0.02). There was
significant correlation between visual deficits and bilateral parieto-occipital
white matter signal changes (P=0.03). There was no other EEG-MRI or
clinical-MRI correlation. MRI abnormalities in SSPE are diverse and may or may
not reflect underlying pathology. Visual deficits were observed in patients
with parieto-occipital white matter signal change. Restricted diffusion of
signal abnormalities and lactate peak in magnetic resonance spectroscopy were
uncommon and it may add to better understanding.
