This report was based on 32 cases with involvement of the central nervous system-encephalitis or encephalopathy in association with an attack of measles, which were observed at the Department of Pediatrics of Keio University and Tokyo Women's Medical College f rom January 1959 to March 1970.
1) The diasease was more frequent at a younger age. 20 cases (62.5%) were in the 7 months-4 years of age group.
2) The onset of central nervous complications occurred most commonly between the third and fourth day after the first apperance of the rash.
3) The material was classified according to the clinical types, which had been previously shown by Ford, F. R.
Symptoms of diffuse cerebral involvement of brief duration was observed in 12 cases (37.5%), signs of multiple focal or diffuse lesions in the nervous system in 8 cases (25.0%), signs of single focal cerebral lesions in 8 cases (25.0%), cerebellar syndromes in 1 case (3.1%), and spinal syndromes in 3 cases (9.1%), optic neuritis was none.
4) All of 11 cases with signe of single focal cerebral lesions and spinal syndromes were under 4 years of age.
5) The most frequent signs and symptoms in the acute stage of the disase were loss of consciousness (90.6%), convulsions (65.6%), pathological reflexes (65.6%), and exaggerated deep reflexes (43.8%). Other signs and symptoms noted, but less frequent, were vomiting, Kernig's sign, absent or sluggish deep and superficial reflexes, and ankle clonus. Hemiplegia was observed in 8 cases (25.0%).
6) The spinal fluid cell count and protein content were nearly always normal under 3 years of age, but extremely variable above 3 years of age.
7) There was one death in our series of 32 cases, of the 31 survivors 21 cases (43.8%) recovered completely, 17 cases (53.1%) had neurological sequelae. The prognosis was good in symptoms of diffuse cerebral involvement of brief duration, but poor in signs of multiple focal or diffuse lesions in the nervous system and single focal cerebral lesions. The commonest sequelae were paralysis (11 of 17 cases, 64.7%), mental deterioration (6 cases, 35.3%), and convulsion (4 cases, 23.5%).
8) The clinical features of prognostic significance regarding neurological sequelae were: (i) patients under 3 years of age; (ii) prolonged deep loss of consciousness; (iii) continuous or recurrent convulsions; (iv) Hemiplegia. Whereas the onset of central nervous complications in relation to the rash, hyperpyrexia, and spinal fluid findings seemed to bear no relation to the prognosis.
9) An analysis of the relationship between the sequelae and treatment (ACTH or steroids, γglobulin) was not possible because of the relatively small number of cases in each group.
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