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Published on: September 8, 2021
Proton magnetic resonance spectroscopy in three subacute sclerosing panencephalitis patients: correlation with
Handan Cakmakci1, Semra Kurul, Akin Iscan
1Department of Radiology, Dokuz Eylül University Faculty of Medicine, 35340 Balcova, Turkey. cakmakh@egenet.com.tr
Introduction:
Subacute sclerosing panencephalitis is progressive, fatal encephalitis caused by a persistent defective measles virus in the central nervous system. The diagnosis is based upon characteristic clinical manifestations, the presence of characteristic periodic EEG discharges, and demonstration of elevated antibody titer against measles in the plasma and cerebrospinal fluid. There has been no correlation between the clinical status and the MRI findings.
Methods:
We performed single voxel magnetic resonance spectroscopy (MRS) on white matter areas that appeared normal or abnormal on conventional MRI in three patients with different clinical stages.
Results:
N-acetyl aspartate:creatine ratios were decreased and choline:creatine ratios were increased in white matter lesions in the late stages of the disease. A lactate peak was observed in a patient in the last stage of the disease. Increased myoinositol:creatine ratio was seen in white matter areas on conventional MRI and in the white matter lesions at early stage of the disease, before neuronal loss.
Insights
Subacute sclerosing panencephalitis (SSPE) involves measles virus in the brain. Magnetic resonance spectroscopy (MRS) reveals metabolic changes in white matter, indicating disease progression before neuronal loss.
Area of Science:
- Neurology
- Neuroscience
- Biochemistry
Background:
- Subacute sclerosing panencephalitis (SSPE) is a fatal, progressive neurological disease.
- Caused by persistent measles virus infection in the central nervous system.
- Diagnosis relies on clinical signs, EEG, and elevated measles antibodies; MRI findings lack clinical correlation.
Purpose of the Study:
- To investigate metabolic changes in white matter using magnetic resonance spectroscopy (MRS) in SSPE patients.
- To correlate MRS findings with clinical stages and conventional MRI in SSPE.
Main Methods:
- Single voxel magnetic resonance spectroscopy (MRS) was performed.
- MRS targeted white matter areas (normal and abnormal on conventional MRI).
- Three patients at different clinical stages of SSPE were studied.
Main Results:
- Decreased N-acetyl aspartate:creatine ratios and increased choline:creatine ratios were observed in late-stage white matter lesions.
- A lactate peak was detected in a final-stage patient.
- Increased myoinositol:creatine ratios were found in early-stage white matter, preceding neuronal loss.
Conclusions:
- MRS can detect early white matter metabolic alterations in SSPE.
- Metabolic changes correlate with disease stage and progression.
- MRS may offer insights into SSPE pathogenesis and monitoring.
