Subacute Sclerosing Panencephalitis Case Presenting with Cortical Blindness: Early Diagnosis with MRI and MR Spectroscopy

Abstract

subacute sclerosing panencephalitis (sspe), chronic progressive inflammatory disorder of the central nervous system, is associated with the presence of persistent and aberrant measles virus infection. The diagnosis is based on characteristic clinical features, periodic electroencephalographic complexes, and elevated measles antibody titer in cerebrospinal fluid. Ocular changes occur approximately in 50 % of cases, but rarely presenting as a first symptom [1]. Visual system abnormalities in SSPE include retinal vasculitis, maculopathy, chorioretinitis, optic neuritis, papillitis, papilledema, optic atrophy, nystagmus, cranial nerve palsies and transient hemianopia, and acute vision loss because of cortical involvement. The most common ocular manifestations are because of macular retinitis and macular pigment disturbances [2–4]. In the beginning, during brain conventional magnetic resonance imaging (MRI) findings are normal, though magnetic resonance spectroscopy (MRS) of SSPE patient may show some abnormalities [1, 5]. Our patient’s neurologic and fundoscopic examination and laboratory findings were normal except loss of visual acuity and abnormal brain MRI and MRS findings. Herein, we report a case of cortical blindness diagnosed as SSPE with the help of neuroimaging without the classical clinical presentation of central nervous system involvement initially.