Adult onset subacute sclerosing panencephalitis presenting with acute ischemic stroke

Abstract

Subacute sclerosing panencephalitis (SSPE) is a progressive, invariably fatal inflammatory disease of the brain, owing to persistent measles virus infection. It generally presents in childhood or adolescence, and usual presentation is with progressive cognitive decline and myoclonic jerks. An adult male, with an uneventful past medical history, presented with a rapidly progressive dementia and generalised myoclonus. During the course of his admission, he developed right sided spastic hemiparesis with evidence of subcortical infarct on brain imaging with focal narrowing of left middle cerebral artery. Subsequently diagnosed as SSPE, he was managed conservatively, without improvement. Intrathecal interferon could not be given owing to lack of consent from the patient’s relatives. Histopathological confirmation could not be done for the same reason. A medium to small vessel intracranial vasculitis, secondary to measles virus infiltration was a proposed explanation of the vascular event. Persistence of measles virus in the brain may be a potential risk factor for intracranial vasculitis and strokes.