Bilateral Macular Retinitis as the Presenting Feature of Subacute Sclerosing Panencephalitis

Department of Uveitis, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India.
Journal of Neuro-Ophthalmology (Impact Factor: 1.95). 01/2008; 27(4):288-91. DOI: 10.1097/WNO.0b013e31815b98e6
Source: PubMed


Two patients presented with retinitis as the initial clinical manifestation of subacute sclerosing panencephalitis (SSPE), a delayed neurologic complication of measles. In one patient, the ocular involvement preceded the neurologic symptoms by 4 weeks and in the other patient by 4 years. The diagnosis of SSPE was suspected when neuropsychiatric manifestations appeared and was confirmed by the typical panencephalitic electroencephalography changes, neuroimaging features of panencephalitis, and high titers of measles antibodies in serum and cerebrospinal fluid. Although SSPE is an untreatable illness, recognition of this unusual presentation is valuable to allow earlier diagnosis and institution of palliative measures.

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    ABSTRACT: To determine the clinical course of Subacute Sclerosing Panencephalitis (SSPE) and different factors affecting the clinical course. Descriptive study. The Children's Hospital, Lahore, from October 2005 to May 2008. All serologically confirmed patients of SSPE were registered and clinical staging of these patients were done from stage-I to stage-IV. Clinical course of these patients was classified by using neurological disability index as fulminant, acute, subacute, and chronic course. Clinical course was analyzed for any difference with age, gender, immunization for measles, measles infection, nutritional status and correlation with age of onset of SSPE, (Spearman's correlation), using statistic package for social science (SPSS) V. 14. A total of 57 cases (41 males, 16 females) with mean age of 7.45 years were studied. Forty (71.4%) of them were vaccinated with single dose at about 9 months of age, 41% (23/57) had measles infections ≤ 2 years of age. Using the Neurology Disability Index for these patients 10.5% had fulminant, 17.5% had acute, 49.2% subacute and 22.8% had chronic course. Age, gender, age at measles infection, SSPE onset age and nutritional status were poor predictors of clinical course of SSPE. Unvaccinated patients showed significantly more rapid course of disease (p = 0.04). Clinical course of SSPE cannot be predicted at the onset of this catastrophic disorder. Children not immunized against measles had a significant rapid course of disease.
    Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 10/2010; 20(10):671-4. DOI:10.2010/JCPSP.671674 · 0.35 Impact Factor

  • Journal of Pediatric Ophthalmology & Strabismus 07/2011; 48(4):255. DOI:10.3928/01913913-20110623-01 · 0.75 Impact Factor
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    ABSTRACT: The typical clinical presentation of subacute sclerosing panencephalitis (SSPE) includes behavioral and intellectual changes followed by myoclonia. However, there are a considerable number of SSPE cases which present with distinct clinical features that can lead to a diagnostic difficulty. In this report, we summarize the clinical features of patients with SSPE who have uncommon presentations or features of the disease or coexisting medical conditions which may lead to diagnostic difficulties. We studied 173 patients, all under the age of 17. Patients were included in the study group according to following criteria: onset of the disease before age 2 years, seizures occurring before the onset of myoclonia and/or behavioral symptoms, extrapyramidal or cerebellar signs and ocular manifestations as initial presenting symptoms, fulminant course including coma or death within 6 months. Additionally, patients with onset of SSPE at the setting of a known neurological disorder are defined as another group in the study. Out of 173 patients with SSPE who were followed in two neurology centers, 31 (17.9%) met our criteria. We found a relative high frequency of these clinical features. Our findings suggest that clinicians should be aware of this clinical characteristics and rule out the disease in cases were other common causes have been excluded, especially in countries with insufficient measles immunization.
    Child s Nervous System 12/2011; 27(12):2041-4. DOI:10.1007/s00381-011-1603-x · 1.11 Impact Factor
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