Computed tomographic findings of early subacute sclerosing panencephalitis

Epidemiological Findings and Clinical and Magnetic Resonance Presentations in Subacute Sclerosing Panencephalitis

Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, inflammatory neurodegenerative disease. This study investigated the relationships of clinical stage with epidemiological and magnetic resonance imaging (MRI) findings in SSPE by retrospective review of 76 cases (57 male) diagnosed by typical periodic electroencephalographic features, clinical symptoms and elevated measles antibody titre in cerebrospinal fluid. Clinical stage at diagnosis was I or II in 48 patients, III in 25 and IV in three. Prominent findings at presentation were atonic/myoclonic seizures (57.9%) and mental deterioration with behaviour alteration (30.3%). Frequent MRI findings (13 – 32 patients) were subcortical, periventricular and cortical involvement and brain atrophy; the corpus callosum, basal ganglia, cerebellum and brainstem were less frequently involved. Five patients had pseudotumour cerebri. Cranial MRI at initial diagnosis was normal in 21 patients (19 stage I/II, two stage III/IV). Abnormal MRI findings were significantly more frequent in the later stages, thus a normal initial cranial MRI does not exclude SSPE, which should, therefore, be kept in mind in childhood demyelinating diseases even when the presentation is unusual.

Subacute sclerosing panencephalitis. Imaging and clinical correlation

Twenty-one patients at different clinical stages of subacute sclerosing panencephalitis were studied by magnetic resonance imaging and computed tomography. In patients in the early clinical stage, the imaging studies appeared normal. Within 6 months, diffuse or focal areas of high signal on T2-weighted magnetic resonance images were evident. Progressive hemispheric, cerebellar, and brainstem atrophy was seen later. Lesions of the deep nuclei were noted frequently in patients in the early and intermediate stages, with the lentiform involved more than the caudate. Magnetic resonance imaging was better than computed tomography in illustrating white matter and basal ganglia abnormalities. Radiographic progression occurred regardless of clinical course.

Magnetic resonance imaging of inflammatory and demyelinating white-matter diseases of childhood

Magnetic resonance imaging (MRI) was performed on 36 children and two adults (with clinical presentation during childhood) with white-matter disease of the central nervous system. Abnormalities were readily demonstrated in patients with multiple sclerosis, acute disseminated encephalomyelitis, leucodystrophies and subacute sclerosing panencephalitis: MRI demonstrated the extent and distribution of abnormalities more clearly than computed tomography for all these disorders. The abnormalities tended to be asymmetrical and multifocal in multiple sclerosis and acute disseminated encephalomyelitis, and more confluent and symmetrical in the leucodystrophies. Children with clinically isolated optic neuritis had a significantly lower frequency of MRI brain-lesions than adults with the same disorder. MRI should be regarded as the radiological investigation of choice when white-matter disease is suspected in children.

Subacute sclerosing panencephalitis. Changes on CT scan during acute relapse

A 19-year-old female patient presented in an acute state of akinetic mutism. Serological analysis of serum and cerebrospinal fluid demonstrated the presence of antibodies to measles virus. CT scan carried out during this acute phase of relapse demonstrated white matter enhancement affecting the cortical white matter of the frontal lobes and corpus callosum. These features indicate that active demyelination occurs during acute relapse in subacute sclerosing panencephalitis (SSPE) and suggest that immunotherapy should be considered during this acute phase.

Computed tomography in subacute sclerosing panencephalitis: report of 15 cases

Computerized tomographic (CT) study of the brain was performed in 15 cases of subacute sclerosing panencephalitis (SSPE). Most patients in Stage II (6/8) had cerebral edema and diffuse white matter low attenuation, and patients in Stages III and IV (5/7) had atrophy of cerebral cortex, brainstem and cerebellum. Low density areas in deep grey matter nuclei (5 cases), large focal areas of white matter hypodensity (3/15) and evidence of brainstem atrophy without cerebral atrophy (2/15) were features not hitherto described. One patient in Stage III had normal scan. Correlation of scan findings was better with the stage of the disease than with the duration of SSPE.

Focal MRI findings in early SSPE

Many investigators have identified localized cortical involvement in subacute sclerosing panencephalitis (SSPE) by clinical and electrophysiologic criteria. Some investigators have reported such abnormalities in the posterior cerebrum early in the course of the disease, but without radiologic correlation. Recently, magnetic resonance imaging has been used to follow the progression of SSPE. The largest reported study of SSPE utilizing magnetic resonance imaging indicated that focal abnormalities were distinctly rare and actually mitigated against the diagnosis of SSPE. We report an SSPE patient with focal cerebral dysfunction and magnetic resonance imaging evidence of distinctly focal inflammatory disease early in the course of the illness.

Serial magnetic resonance imaging in subacute sclerosing panencephalitis

Magnetic resonance (MR) imaging of a 17-year-old girl with subacute sclerosing panencephalitis (SSPE) was done several times to monitor the morphological changes and clinical course of the disease by comparison with computed tomographic (CT) scans. The MR image showed lesions that corresponded to the clinical symptoms in the early stages where no abnormalities appeared on the CT scans. The MR images delineated the extent of abnormal areas more clearly than the CT scans. However, the course of neurological manifestations did not always correspond to the MR findings. Serial MR imaging was useful in the detection and observation of the stages and clinical progress of SSPE.

Magnetic resonance and CT imaging correlated with clinical status in SSPE

Five patients afflicted with subacute sclerosing panencephalitis were studied with computed tomography and magnetic resonance imaging. Computed tomography documented changes of nonspecific cerebral atrophy and low attenuation in the subcortical white matter. Magnetic resonance imaging revealed bilateral, symmetric, and diffuse abnormal increased signal in the white matter of the cerebral hemispheres with normal posterior fossa structures in 4 of 5 patients. Magnetic resonance imaging was superior to computed tomography in demonstrating the total extent of abnormality and may be the imaging modality of choice for this childhood disease.

Computed tomography of the brain in subacute sclerosing panencephalitis

Twenty-four computed tomographic scans of 12 patients with confirmed subacute sclerosing panencephalitis were studied using standardized techniques of radiological assessment. Abnormalities encountered were of four types--(1) lateral ventricular dilatation, (2) cerebral cortical atrophy and sylvian fissure widening, (3) low parenchymal attenuation, and (4) brainstem atrophy and cerebellar atrophy--and of varying degrees. The abnormalities correlated best with the stage and duration of disease, but not necessarily well with the patient's mental state. The fewest radiological abnormalities were encountered in the acute or early stages, whereas more signs of parenchymal disturbances in the form of low attenuations emerged during intermediate periods. Chronic periods were accompanied by atrophic changes in the form of cortical atrophy, ventricular dilatation, and brainstem cerebellar atrophy.

Progressive CT abnormalities despite clinical improvement in SSPE treated with inosiplex

Inosiplex has been utilized in the treatment of subacute sclerosing panencephalitis (SSPE), though without unequivocally established beneficial effect. We report a patient whose computerized tomographic (CT) scans demonstrated the development of progressive cerebral atrophy and multifocal white matter lesions despite continuous treatment with inosiplex and periods of considerable clinical improvement or stabilization. The findings suggest that inosiplex may not have altered the pathological consequences of SSPE and that clinical staging categories alone may not be reliable long-term correlates of the progression of the disease. Controlled studies utilizing assessment of brain mass by CT scan or other imaging devices in addition to clinical staging are required to evaluate the efficacy of inosiplex.