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Abstract Details

PISA Syndrome in Subacute Sclerosing Pan Encephalitis: Case Report and Review of Literature
Infectious Disease
P1 - Poster Session 1 (9:00 AM-5:00 PM)
224

To report PISA syndrome, a rare movement disorder, in a young patient of Subacute sclerosing panencephalitis (SSPE).

SSPE is a slowly progressive central nervous system disorder affecting children and young individuals caused by persistent mutant measles virus. Extra-pyramidal manifestations like tics, dystonia, parkinsonism, chorea and others have been described in literature in SSPE. We, here report PISA syndrome (reversible lateral bending of the trunk with a tendency to lean to one side) in a young male with SSPE.

A 23-year-old male presented in clinic with 2-year complaints of recurrent falls, decrease scholastic performance, personality changes, jerky movements of body, especially right upper limb. Since last 1 month patient also has right sided tilt of body in sitting and/or standing position, with tendency to fall on right side. Vaccination was incomplete in this patient but specific measles like eruptions in childhood were not there. No significant family history was present. On examination, patient had severe impairment in higher mental functions. Decreased blink rate and symmetrical bradykinesia was present but no tremors were evident. He was tilting towards right side on sitting, standing and walking, and had a tendency to fall on right side on standing suggesting PISA syndrome.

On evaluation, patient’s MRI brain showed T2 hyper-intense signals in occipito-parietal and frontal lobes. Electroencephalography of patient showed periodic stereotyped high voltage discharges. CSF measles IgG anti-bodies were significantly high confirming the diagnosis of SSPE.
Only 2 similar case of PISA syndrome in SSPE has been reported in literature. PISA syndrome usually occurs due to dopaminergic deficiency and/or cholinergic excess, but the exact pathogenesis of Pisa syndrome in SSPE is unclear. Still, in young onset Parkinsonism with PISA syndrome, possibility of SSPE should be kept.
Authors/Disclosures
Amit S. Singh, MD (Linux Laboratories Pvt Ltd)
PRESENTER
Dr. Singh has nothing to disclose.
Jeenendra P. Singhvi, MD, FAAN Dr. Singhvi has nothing to disclose.