Atypical neuroimaging findings with involvement of brainstem and cerebellum as well as basal ganglia in a case of SSPE misinterpreted as glioma

Abstract

Subacute sclerosing panencephalitis (SSPE) is a progressive central nervous system disorder, presents after a latent period of 6 years or more from an acute measles infection and has an insidious onset of neurological dysfunction associated with myoclonus and seizure activity. It progresses to coma and death within 1 or 2 years of onset. Brain magnetic resonance imaging (MRI) in SSPE shows lesions usually involving the parieto-occipital and cortico-subcortical regions asymmetrically in the early stage. In later stage of SSPE, symmetric periventricular white-matter changes become more prominent on MRI. Here we describe a case report of a child with SSPE with brain MRI showing extensive brainstem and cerebellum involvement with additional lesion in the basal ganglia, these findings are rarely described with SSPE, and hence low-grade glioma was initially reported by radiologist. Thus, one has to be aware of such extensive brainstem and cerebellum involvement on MRI in SSPE.

Keywords

SSPE - neuroregression - myoclonic jerks - MRI - brainstem - cerebellum