Periodic Lateralized Epileptiform Discharges in Fulminant Form of SSPE

Cherian, Ajith; Sreedharan, Sapna Erat; Raghavendra, S.; Nayak, Dinesh; Radhakrishnan, Ashalatha

doi:10.1017/s0317167100007952

Cited by 7 publications

(8 citation statements)

References 12 publications

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“…Fulminant SSPE is a major diagnostic challenge because it can present with atypical features. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 Focal neurological deficits as an initial manifestation are very rare and may mislead the diagnosis. 2 , 10 , 11 Our patient presented with ataxia and right hemiplegia and did not have any visual symptoms, seizures, or slow generalized myoclonus at the initial presentation.…”

Section: Discussionmentioning

confidence: 99%

“…Atypical features such as acute vision loss, dysarthria, ataxia, focal and generalized seizures, epilepsia partialis continua, acute encephalitis, focal deficit, and asymmetric myoclonus have been noted. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 EEGs may also be atypical, showing periodic lateralized epileptiform discharges. 10 We report herein a patient manifesting initially with ataxia, right hemiparesis, and asymmetrical delta-range slowing on EEG prior to the onset of Rademecker complexes, which are pathognomonic of SSPE.…”

Section: Introductionmentioning

confidence: 99%

“… 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 EEGs may also be atypical, showing periodic lateralized epileptiform discharges. 10 We report herein a patient manifesting initially with ataxia, right hemiparesis, and asymmetrical delta-range slowing on EEG prior to the onset of Rademecker complexes, which are pathognomonic of SSPE. This case illustrates that a clinical picture suggestive of acute focal encephalitis could actually be a manifestation of fulminant SSPE.…”

Section: Introductionmentioning

confidence: 99%

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Fulminant Subacute Sclerosing Panencephalitis Presenting with Acute Ataxia and Hemiparesis in a 15-Year-Old Boy

et al. 2014

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BackgroundSubacute sclerosing panencephalitis (SSPE) is a delayed and fatal manifestation of measles infection. Fulminant SSPE is a rare presentation in which the disease progresses to death over a period of 6 months. The clinical features are atypical and can be misleading.Case ReportWe report herein a teenage boy who presented with acute-onset gait ataxia followed by right hemiparesis that evolved over 1 month, with left-hemispheric, delta-range slowing on the electroencephalogram (EEG). Magnetic resonance imaging disclosed multiple white-matter hyperintensities, suggesting a diagnosis of acute disseminated encephalomyelitis. He received intravenous steroids, and within 4 days of hospital admission he developed unilateral slow myoclonic jerks. Repeat EEG revealed Rademecker complexes, pathognomonic of SSPE, and an elevated titer of IgG antimeasles antibodies was detected in his cerebrospinal fluid. The disease progressed rapidly and the patient succumbed within 15 days of hospitalization. The diagnosis of SSPE was confirmed by autopsy.ConclusionsThis case illustrates the difficulty of recognizing fulminant SSPE when it manifests with asymmetric clinical and EEG abnormalities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fulminant Subacute Sclerosing Panencephalitis Presenting with Acute Ataxia and Hemiparesis in a 15-Year-Old Boy

et al. 2014

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“…A possible consequence of electrical coupling is the rapid and efficient electrotonic spread of paroxysmal burst discharges from cell to cell, thus facilitating synchronous bursting within a pool of neurons. [10] The EEG correlate would be epileptiform discharges, and periodic synchronous bursting will occur if a burst in one cell is capable of inducing bursting in neighboring cells. Relative integrity of the cortex is critical for the appearance of these complexes as in PRES where the damage is more to white than gray matter.…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome with PLEDs-plus due to mesalamine

Cherian

Soumya

Iype

et al. 2014

Journal of Neurosciences in Rural Practice

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A 32-year-old lady developed status epilepticus and acute visual loss while on mesalamine for Crohn's disease. Her clinical course and magnetic resonance imaging (MRI) were suggestive of posterior reversible encephalopathy syndrome (PRES). She had periodic lateralized epileptiform discharges plus (PLEDs-plus) on electroencephalogram (EEG), which responded to sodium valproate. Her vision improved from counting fingers at one-meter distance to 6/12. Though different cytotoxic drugs have been implicated as causative agents, this is the first case report of mesalamine-induced PRES. This case highlights the need for aggressive treatment of PLEDs-plus with EEG monitoring using a broad-spectrum antiepileptic drug like valproate, which has contributed to the rapid reversibility of vision in PRES subjects, and the need for a thorough drug history for etiological clues.

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“…In few patients focal seizures in the form of epilepsia partialis continua and an EEG showing Periodic Lateralizing Epileptic Discharges (PLED) were reported. This pattern was associated with a fulminant course (Santoshkumar & Radhakrishnan 1996, Cherian et al, 2009). As mentioned above, earlier publications indicated that epileptic seizures are rare and appear at late stages of the disease.…”

Section: Characteristic Clinical Featuresmentioning

confidence: 99%

Subacute Sclerosing Pan-Encephalitis (SSPE) – Past and Present

Gadoth¹

2011

Pathogenesis of Encephalitis

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Periodic Lateralized Epileptiform Discharges in Fulminant Form of SSPE

Cited by 7 publications

References 12 publications

Fulminant Subacute Sclerosing Panencephalitis Presenting with Acute Ataxia and Hemiparesis in a 15-Year-Old Boy

Fulminant Subacute Sclerosing Panencephalitis Presenting with Acute Ataxia and Hemiparesis in a 15-Year-Old Boy

Posterior reversible encephalopathy syndrome with PLEDs-plus due to mesalamine

Subacute Sclerosing Pan-Encephalitis (SSPE) – Past and Present

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