Neurological complications of measles

Abstract

Objective: To study the clinical features and course of neurological complications of measles.

Design: Prospective study.

Setting: Neurology Unit, Teaching Hospital, Kandy.

Patients: 10 patients admitted with neurological complications of measles during an outbreak.

Measurements: Assessment of clinical features and the neurological investigations.

Results: 6 had CSF IgM antibodies confirming a recent measles infection. 7 patients had encephalitis and 3 had myelitis. Complications had appeared 5 to 14 days after appearance of the rash. All patients with encephalitis had depressed level of consciousness (Glasgow coma scale 2 to 11) with seizures, 3 patients had lateralising signs, and assisted ventilation was required in 4. Cranial CTs were either normal or showed mild cerebral oedema. CSF analysis showed either normal or mildly raised protein without a cellular reaction. EEG in all 7 revealed diffuse delta activity. During the follow up period of 1 to 12 weeks, all showed a gradual improvement, except one who succumbed to respiratory complications of assisted ventilation. All others were left with some residual disability when last seen. Three patients with myelitis had symmetrical paraparesis. CSF protein was 60 to 80 mg/ml without a cellular reaction. All three improved without residual disability.

Conclusions: Measles encephalitis is a life threatening complication. All three myelitis patients recovered completely within 5 to 8 weeks.