Bilateral Subretinal Fluid and Retinal Vasculopathy Associated With Subacute Sclerosing Panencephalitis

Agarwal, Aniruddha; Singh, Ramandeep; Kumar, Abiraj; Dogra, Mangat R; Ak, Gupta

doi:10.1097/icb.0000000000000314

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…5 In our case, multifocal retinitis with retinal atrophy was the most common visual sign of SSPE. The bilaterality and rapid progression of the lesion to healing have been reported previously 6 In addition, patients may also have linear-shaped arcuate lesions and dilated veins, 4 or bilateral macular retinitis associated with pale optic disk. 4 In a patient presenting with chorioretinitis, Paul et al 7 have demonstrated numerous filamentous, microtubular, and intranuclear viral inclusions in the nuclear layers of the retina consistent with the measles virus.…”

Section: Discussionsupporting

confidence: 60%

“…It can have associated retinal changes such as hemorrhage, edema, optic atrophy, papillitis, serous macular detachments, macular edema, vascular occlusions, venous dilatation, and retinal pigment epithelial detachments with hardly any vitreous inflammation. [3][4][5][6] These characteristics help differentiate SSPE from other inflammatory retinal diseases, including Bechet illness and toxoplasmosis. 5 In our case, multifocal retinitis with retinal atrophy was the most common visual sign of SSPE.…”

Section: Discussionmentioning

confidence: 99%

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A 12-year-old Asian Indian boy with bilateral rapidly progressive necrotizing Macular Retinitis

Rana

Sharma²,

Arora

et al. 2022

RETINAL Cases &Amp; Brief Reports

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

A 12-year-old Asian Indian boy with bilateral rapidly progressive necrotizing Macular Retinitis

Rana

Sharma²,

Arora

et al. 2022

RETINAL Cases &Amp; Brief Reports

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“…Necrotizing chorioretinitis is characterized by dilated tortuous veins, retinal hemorrhages with subretinal exudates and retinal and macular pigmentary changes. The healed retinal scar, with well‐defined borders around the central retinal atrophy, is seen in long‐standing cases . Chorioretinitis occurs as a result of measles viral invasion (Figure and Table ).…”

Section: Ophthalmological Manifestationsmentioning

confidence: 99%

Subacute sclerosing panencephalitis

Garg

Mahadevan

Malhotra

et al. 2019

Reviews in Medical Virology

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Summary Subacute sclerosing panencephalitis (SSPE) is a slowly progressive brain disorder caused by mutant measles virus. SSPE affects younger age groups. SSPE incidence is proportional to that of measles. High‐income countries have seen substantial decline in SSPE incidence following universal vaccination against measles. SSPE virus differs from wild measles virus. Measles virus genome recovered from the autopsied brain tissues demonstrates clustered mutations in virus genome particularly in the M gene. These mutations destroy the structure and functioning of the encoded proteins. Complete infectious virus particle has rarely been recovered from the brain. Human neurons lack required receptor for entry of measles virus inside the neurons. Recent in vitro studies suggest that mutations in F protein confer hyperfusogenic properties to measles virus facilitating transneuronal viral spread. The inflammatory response in the brain leads to extensive tissue damage. Clinically, SSPE is characterized by florid panencephalitis. Clinically, SSPE is characterized by cognitive decline, periodic myoclonus, gait abnormalities, vision loss, and ultimately to a vegetative state. Chorioretinitis is a common ocular abnormality. Electroencephalography (EEG) shows characteristic periodic discharges. Neuroimaging demonstrates periventricular white matter signal abnormalities. In advanced stages, there is marked cerebral atrophy. Definitive diagnosis requires demonstration of elevated measles antibody titers in cerebrospinal fluid (CSF). Many drugs have been used to stabilize the course of the disease but without evidence from randomized clinical trials. Six percent of patients may experience prolonged spontaneous remission. Fusion inhibitor peptide may, in the future, be exploited to treat SSPE. A universal vaccination against measles is the only proven way to tackle this menace currently.

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“…However, subacute sclerosing panencephalitis is characterized by full-thickness rapidly progressive necrotizing retinitis which was not consistent with the imaging findings in our patient. 7 Although the serpentine retinal lesions suggested a subretinal “worm,” the lack of vitritis and bilateral findings with mostly central involvement did not support the diagnosis of a parasitic infection. 8 The possibility that the retinal findings were due to IgG4-related disease was also considered.…”

Section: Case Reportmentioning

confidence: 95%

SELF-INFLICTED LASER-INDUCED MACULOPATHY MASQUERADING AS POSTERIOR UVEITIS IN A PATIENT WITH SUSPECTED IgG4-RELATED DISEASE

Agarwal

Jindal

Anjani

et al. 2019

RETINAL Cases &Amp; Brief Reports

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A young man on systemic corticosteroids for presumed IgG4-related disease presented with bilateral sudden progressive visual loss associated with multiple outer retinal abnormalities. Clinical examination and multimodal retinal imaging revealed findings highly suggestive for self-inflicted handheld laser-induced maculopathy. This case highlights the importance of prompt recognition of highly characteristic clinical and imaging features of laser-induced maculopathy with the hope to prevent further irreversible loss of vision.

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Bilateral Subretinal Fluid and Retinal Vasculopathy Associated With Subacute Sclerosing Panencephalitis

Cited by 7 publications

References 10 publications

A 12-year-old Asian Indian boy with bilateral rapidly progressive necrotizing Macular Retinitis

A 12-year-old Asian Indian boy with bilateral rapidly progressive necrotizing Macular Retinitis

Subacute sclerosing panencephalitis

SELF-INFLICTED LASER-INDUCED MACULOPATHY MASQUERADING AS POSTERIOR UVEITIS IN A PATIENT WITH SUSPECTED IgG4-RELATED DISEASE

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