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31‐YEAR‐OLD MAN WITH BALINT'S SYNDROME AND VISUAL PROBLEMS

A 31-year-old man presented with Balint’s syndrome. Radiology studies suggested an inflammatory demyelinating process within the occipital and parietal lobes. A cystic sellar/suprasellar mass was also found. Neuroimaging 2.5 years later showed progression of the lesions and growth of the tumor. Based on elevated antimeasles antibody titers in the cerebrospinal fluid subacute sclerosing panencephalitis (SSPE) was diagnosed. After 4 years of disease the patient died in a decerebrate state with tetraparesis. Neuropathological examination showed brain atrophy with discoloration and irregular induration of the white matter. The sellar tumor was a craniopharyngioma. Microscopically a chronic and active panencephalitis was revealed with intranuclear inclusions. Ultrastructural examination confirmed SSPE by demonstrating measles virus nucleocapsids within the inclusions. SSPE is a rare progressive neurological disorder caused by persistent defective measles virus infection and is usually seen in children and young adults. This disease has been eradicated in many countries by obligatory immunization. This case demonstrates, however, that SSPE should still be considered in the neurological and neuropathological differential diagnoses even in adult patients. Furthermore this is a first reported case of SSPE coexisting with a brain tumor (craniopharyngioma). Correspondence 530 Brain Pathology 19 (2009) 527–530 © 2009 The Authors; Journal Compilation © 2009 International Society of Neuropathology