Changing patterns of glucose metabolism during the course of subacute sclerosing panencephalitis as measured with18FDG-positron-emission tomography

Abstract

18FDG-positron emission tomography performed at different stages in the course of subacute sclerosing panencephalitis revealed a changing pattern of metabolic disturbance. In clinical stage II patients the inflammation in the basal ganglia appeared to lead to neuronal excitation accompanied by hypermetabolism. Widespread cortical functional inhibition of metabolism followed. The striatal inflammation ended with necrosis and hypometabolism, with resulting functional cortical disinhibition; later, deep midbrain structures and brain stem became hypermetabolic. A patient clinically in remission showed no such changes in cerebral glucose metabolism.

Subacute Sclerosing Panencephalitis Presenting as Choreoathetosis and Basal Ganglia Hyperintensities

“…Although positron emission tomography has shown inflammatory hypermetabolism early on in the basal ganglia, the radiological involvement appears in later stages. 11 Sawaishi et al demonstrated migratory hyperintensities with edematous appearance of the whole lenticular nucleus in a patient with SSPE; however, the lesions began first in the periventricular white matter and subsequently spread to the deep gray matter in a migratory pattern followed by eventual putaminal atrophy. 12 In general, the basal ganglia lesions reported in SSPE remain restricted to the putamen and/or caudate with sparing of globus pallidus and thalamus.…”

Subacute Sclerosing Panencephalitis Presenting as Choreoathetosis and Basal Ganglia Hyperintensities

“…Although positron emission tomography has shown inflammatory hypermetabolism early on in the basal ganglia, the radiological involvement appears in later stages. 11 Sawaishi et al demonstrated migratory hyperintensities with edematous appearance of the whole lenticular nucleus in a patient with SSPE; however, the lesions began first in the periventricular white matter and subsequently spread to the deep gray matter in a migratory pattern followed by eventual putaminal atrophy. 12 In general, the basal ganglia lesions reported in SSPE remain restricted to the putamen and/or caudate with sparing of globus pallidus and thalamus.…”

Subacute Sclerosing Panencephalitis with Subclinical Infection

“…[1] Because infants infected with measles are at highest risk for SSPE, it is important to protect them by vaccination and herd immunity. [3] Some cases have no known history of febrile rash illness, but the SSPE diagnosis indicates a subclinical or mild form of infection. [1] SSPE diagnosis during pregnancy has been reported in the literature, suggesting that the altered immune system during pregnancy might permit the virus, if present, to replicate in the central nervous system 4 .…”

“…SSPE is generally a simple diagnosis to make, requiring only CSF antibody testing that can be performed in public health and clinical laboratories. [3]…”

“…As per the recent WHO report, 7 million people were found to be affected with measles in 2016. [3][4][5] Approximately, 38% of Indian children fail to receive the basic immunization in the first year of life. [6] Approximately 50% of the global measles-associated deaths occur in India.…”

Subacute Sclerosing Panencephalitis Presenting as Choreoathetosis and Basal Ganglia Hyperintensities

“…Although positron emission tomography has shown inflammatory hypermetabolism early on in the basal ganglia, the radiological involvement appears in later stages. 11 Sawaishi et al demonstrated migratory hyperintensities with edematous appearance of the whole lenticular nucleus in a patient with SSPE; however, the lesions began first in the periventricular white matter and subsequently spread to the deep gray matter in a migratory pattern followed by eventual putaminal atrophy. 12 In general, the basal ganglia lesions reported in SSPE remain restricted to the putamen and/or caudate with sparing of globus pallidus and thalamus.…”

Subacute Sclerosing Panencephalitis with Subclinical Infection

“…[1] Because infants infected with measles are at highest risk for SSPE, it is important to protect them by vaccination and herd immunity. [3] Some cases have no known history of febrile rash illness, but the SSPE diagnosis indicates a subclinical or mild form of infection. [1] SSPE diagnosis during pregnancy has been reported in the literature, suggesting that the altered immune system during pregnancy might permit the virus, if present, to replicate in the central nervous system 4 .…”

“…SSPE is generally a simple diagnosis to make, requiring only CSF antibody testing that can be performed in public health and clinical laboratories. [3]…”

“…As per the recent WHO report, 7 million people were found to be affected with measles in 2016. [3][4][5] Approximately, 38% of Indian children fail to receive the basic immunization in the first year of life. [6] Approximately 50% of the global measles-associated deaths occur in India.…”

Subacute Sclerosing Panencephalitis Presenting as Choreoathetosis and Basal Ganglia Hyperintensities

“…Although positron emission tomography has shown inflammatory hypermetabolism early on in the basal ganglia, the radiological involvement appears in later stages. 11 Sawaishi et al demonstrated migratory hyperintensities with edematous appearance of the whole lenticular nucleus in a patient with SSPE; however, the lesions began first in the periventricular white matter and subsequently spread to the deep gray matter in a migratory pattern followed by eventual putaminal atrophy. 12 In general, the basal ganglia lesions reported in SSPE remain restricted to the putamen and/or caudate with sparing of globus pallidus and thalamus.…”

Subacute Sclerosing Panencephalitis with Subclinical Infection

“…[1] Because infants infected with measles are at highest risk for SSPE, it is important to protect them by vaccination and herd immunity. [3] Some cases have no known history of febrile rash illness, but the SSPE diagnosis indicates a subclinical or mild form of infection. [1] SSPE diagnosis during pregnancy has been reported in the literature, suggesting that the altered immune system during pregnancy might permit the virus, if present, to replicate in the central nervous system 4 .…”

“…SSPE is generally a simple diagnosis to make, requiring only CSF antibody testing that can be performed in public health and clinical laboratories. [3]…”

“…As per the recent WHO report, 7 million people were found to be affected with measles in 2016. [3][4][5] Approximately, 38% of Indian children fail to receive the basic immunization in the first year of life. [6] Approximately 50% of the global measles-associated deaths occur in India.…”