Atypical Presentation of Fulminating Subacute Sclerosing Panencephalitis: A Case Series

Abstract

Subacute sclerosing panencephalitis (SSPE) is a rare and progressive inflammatory disease of central nervous system due to aberrant measles virus with an outcome that is nearly always fatal. In acute fulminant SSPE, the disease rapidly evolves leading to death within 3 months of the diagnosis. We report here four cases of fulminant SSPE with atypical presentations, two of them presented at very early age with history of congenital measles infection in first case and gait abnormality as initial symptom in second case; acute disseminated encephalomyelitis (ADEM) with refractory seizures in third case, unilateral myoclonus with hemiparesis in fourth case at the onset of disease, respectively. The typical periodic electroencephalographic (EEG) complexes, elevated cerebrospinal fluid (CSF), and serum antimeasles antibodies in our patients led to the diagnosis of SSPE. A high index of clinical suspicion in fulminant type with awareness of atypical features, EEG, and CSF studies are of paramount importance in establishing its diagnosis.

Keywords

subacute sclerosing panencephalitis - atypical - early onset - fulminant - acute disseminated encephalomyelitis - asymmetric presentation - EEG

Financial Disclosure

Nothing.

Contributors' Statement

P.K.D. and A.G. worked up, managed, and collected patient's data and drafted the manuscript. The final manuscript was approved by both the authors.

Publication History

Received: 06 May 2020

Accepted: 11 June 2020

Article published online:
16 October 2020

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