A 16-year-old boy presents with sudden onset double vision and night terrors. There is no history of a concussion. Upon further dwelling, you discover that the patient remains conscious during his alleged episodes of night terrors. MRI shows no lesions or signs of infection. WBC count is within normal range. There is no history of fever.

Interestingly, the parents reveal that the boy was adopted when he was 2 weeks old and was fed with formula milk as there was no further contact with his biological mother from there on. Over the next few days, the patient has multiple episodes of seizures. Organise the above-mentioned facts and give me your diagnosis. (Hint: Focus on the history)

Answer:

So, in this case, we know there is some CNS involvement. But it isn't a tumour nor is it an acute infection. So that hints towards degenerative or autoimmune conditions such as Multiple sclerosis. But an acute confusion state rules out MS. So let us focus on the history. The boy was adopted, so he was deprived of the protection against various diseases that he would have gotten through his biological mother's breast milk. Looking at the clinical picture in this case, we can think of a condition called Subacute Sclerosing Panencephalitis which is a delayed sequela of Measles infection in early childhood. To Diagnose it, we would need to biopsy the Brain or retina. Treatment involves giving intraventricular interferon through an Ommaya Reservoir. Measles is caused by Measles Virus which is an ssRNA virus with a negative sense belonging to paramyxoviridae. It attacks the Lung tissue first, from where it goes to the local lymph nodes and eventually into the bloodstream. From the blood, it reaches more of the lung tissue causing pneumonia, intestines causing diarrhoea and the Brain causing encephalitis.