NEUROLOGICAL DETERIORATION FOLLOWING HEAD-INJURY - THE EYES HAD IT

A 17-year-old male presented with confusion following a mild head inju ry. Repeated CT scans of the head were normal, There was a 3 year hist ory of decreased vision, associated with a focal pigmentary retinopath y, On assessment he demonstrated visual agnosia and early dementia. An MRI scan showed symmetrical demyelination of the white matter, partic ularly of the occipital robes. The diagnosis of subacute sclerosing pa nencephalitis (SSPE) was confirmed by the typical EEG findings and the presence of measles antibodies in the CSF. The head injury was the pr ecipitating factor which led to a diagnosis of SSPE. This disease shou ld be considered in young patients who have persisting cognitive dysfu nction out of keeping with the severity of the initial trauma. A focal pigmentary retinopathy, especially with macular involvement, should a lso raise the possibility of SSPE, despite the absence of neurological symptoms initially. We report the longest interval to date between th e visual symptoms and onset of neurological signs of SSPE.