Subacute Sclerosing Panencephalitis in a 63-Year-Old Woman Presenting as Generalized Choreoathetosis

Abstract

The persistence of measles virus infection in childhood and early adolescence can rarely lead to a fatal progressive neurodegenerative disorder known as subacute sclerosing panencephalitis (SSPE), characterized by behavioral disturbances and intellectual disability followed by myoclonic jerks and occasional negative myoclonus. Movement disorders are rarely presenting manifestations in SSPE. We herein report a 63-year-old woman with generalized choreoathetosis as the presenting manifestation of stage-I SSPE. Our case was atypical for the patient's age and clinical presentation with generalized choreoathetosis and bilateral putaminal and caudate nucleus signal hyperintensity. Though highly uncommon, neurologists should keep SSPE as a differential diagnosis among patients with movement disorders. Measles-endemic countries should be more vigilant to the atypical and rare presentations of SSPE, such as generalized choreoathetosis.

Keywords: choreoathetosis; movement disorders; subacute sclerosing panencephalitis.

Figure 1.

Brain magnetic resonance imaging reveals bilateral putaminal and caudate nucleus signal hyperintensity on the T2-weighted sequence (A) with mild diffusion restriction on the diffusion-weighted image (B). Figures C and D show bilaterally symmetrical triphasic slow waves at regular intervals.