Subacute sclerosing panencephalitis presenting as young adult onset parkinsonism

ABSTRACT

Subacute sclerosing panencephalitis(SSPE) is a fatal chronic persistent encephalitis due to a sequela of measles virus infection. It is almost developed in childhood or school aged children. It's onset after the age of 20 is very rare. In addition, SSPE with prominent parkinsonian features is not common. We experienced a 26-year-old man with bradykinesia, slurred speech and gait disturbance for 1 month. He showed masked face, vertical and right horizontal conjugate gaze limitation, generalized hyperreflexia, rigidity, and myoclonic jerks. His gait was small-stepped festinatinog and propulsive with intermittent freeziong and ignition failure. He had a history of measles at his age of 13. Brain magnetic resonance images and all biochemistries including coper and ceruloplasmin level of serum were normla. Characteristic periodic synchronous discharges were noted on electroencephalogram. The antibody titer to measles virus was highly increased in serum and cerebrospinal fluid. Symptoms rapikly progressed to vegetative state and expired in 9.5 months after the initial symprom. Autopsy was performed. All parts of brain were moderately atrophied. In microscopic examination, diffuse glial and inflammatory changed with neuronal loss throughout the entire brain were noted. So we suggest that the possibility of SSPE may be considered as a cause of young adult onset parkinsonism.