G384(P) Spectrum of mri brain findings in sspe

Abstract

Objectives Subacute sclerosing panencephalitis (SSPE) is a progressive catastrophic neurodegenerative disease because of persistent measles viral infection in the brain. Pakistan has one of the highest incidences of SSPE. Methods We describe the MRI brain findings in 20 paediatric patients with confirmed SSPE with their clinical and EEG correlates. This retrospective study was conducted at Aga Khan University Hospital, Karachi between January 2006 and December 2015. Diagnosis of SSPE was on the basis of the clinical signs and symptoms, the characteristic EEG patterns (burst suppression in the early stage and a diffuse, random, slow arrhythmia pattern in the late stage), and high titers of measles antibody in the CSF. Results The mean age at presentation was 7.4±3.3 years. MRI abnormalities included diffuse white matter changes (n=8), subcortical T2 hyperintesities in 1 and brainstem changes in 2 patients. MRI was normal in 8/20 patients. 1 patient had abnormal signals in the putamen. MRS was done additionally in 4 patients out of which 2 showed decreased NAA/Cr and increased choline/creatinine ratio while 1 was normal and 1 had decreased NAA/Cr ratio only. Conclusion MRI brain to date is supportive in understanding the pathology of SSPE. MRI can be normal in patients with SSPE if done early on at the start of the disease.