Thalamic Syndrome in Children With Measles Infection and Selective, Reversible Thalamic Involvement

Abstract

* Abbreviations: CNS = : central nervous system • MV = : measles virus • CSF = : cerebrospinal fluid • MRI = : magnetic resonance imaging • DCVT = : deep cerebral vein thrombosis • IgM = : immunoglobulin M • IgG immunoglobulin G; CFT = : complement fixation test • PCR = : polymerase chain reaction • ELISA = : enzyme-linked immunosorbent assay • LA = : lupus anticoagulant • APTT activated partial thromboplastin time; MRA = : magnetic resonance angiography • ER = : emergency room • PCUC = : Pediatric Clinic University of Catania • EEG = : electroencephalogram • FSIQ = : full scale IQ • VIQ = : verbal IQ • PIQ = : performance IQ • TS = : thalamic syndrome • aPL = : antiphospholipid antibodies • CDV = : canine distemper virus Neurologic complications are more common in measles than in the other exanthems.1-3 The incidence of acute encephalomyelitis, the most frequent central nervous system (CNS) complication of measles virus (MV) infection, is estimated to be 1 to 2 in 1000 reported cases of measles.1 2 Considerable controversy relates to the mechanisms in acute measles encephalitis:1-3 there is little evidence for detectable MV in the CNS either as assessed directly by virus isolation or by techniques to detect viral antigen or RNA or indirectly by the appearance of MV-specific antibody or MV-induced interferon in the cerebrospinal fluid (CSF).4 These findings, together with pathologic evidence of perivenular demyelination,2 4support hypotheses of an indirect, immune-mediated demyelinating disease not requiring virus invasion of the CNS.5 6Guillain-Barre syndrome, isolated retrobulbar neuritis, cerebellar ataxia, and encephalitis lethargica are other rarer neurologic complications of measles.1-3 7 8Thrombophlebitis of the cerebral veins has been rarely mentioned in measles infection,1 7 and it is of note that in the series of Tyler,7 reported in the era when the infection was so common and ubiquitous among US children, no patients had such a complication. In some unexplained cases of childhood cerebral stroke, measles, or other exanthems in the past history, have been considered to be possible antecedent factors.9 10 To the best of our knowledge, however, none of the reported cases with measles cerebrovascular complications had selective and reversible thalamic involvement or thalamic symptomatology.1-3 7 9 10 We describe 4 children who developed thalamic pain and thalamic analgetic syndromes11-13 during measles infection in association with magnetic resonance imaging (MRI) evidence of deep cerebral vein thrombosis (DCVT) and reversible lesions localized selectively to both capsulothalamic regions. Table 1 summarizes the main clinical features of all 4 of … Address correspondence to: Martino Ruggieri, MD, Division of Pediatric Neurology, Pediatric Clinic, University of Catania, 95125 Catania, Italy.