Neurologic outcome of acute measles encephalitis according to the MRI patterns

Abstract

The aim of this prospective study was to clarify the ramifications of neuroimaging patterns associated with neurologic outcomes of acute measles encephalitis. Twelve patients with neurologic complications stemming from a measles outbreak were diagnosed based on characteristic clinical features, the presence of measles-specific antibodies, and abnormal cerebrospinal fluid findings. Neuroimaging studies were then performed during the acute phase of the disease. Our subject group consisted of four males and eight females (mean age: 9.9 years). Main neurologic findings were loss of consciousness, seizures, and paralysis. Serum tests for measles-specific Ig G and M antibodies were positive in eleven patients. Neuroimages of the group revealed the following three abnormalities: (1). demyelination of white matter with hypoperfusion on interictal single-photon-emission computed tomography, (2). high signal intensity of gray matter with hypoperfusion on interictal single-photon-emission computed tomography, and (3). normal MRI with hypoperfusion on single-photon-emission computed tomography. We identified a new pattern of acute measles encephalitis that involved cortical and/or deep gray matter, and this finding suggests a variant in the pathogenesis of acute measles encephalitis. Patients that demonstrated a gray matter abnormality had a higher rate of complications and required longer periods of hospitalization.