An 8 year old boy is taken to a pediatrician because of behavioral changes, mild intellectual deterioration, and “laziness.” Over the next several months the boy develops increasing clumsiness and periodic, involuntary, jerky movements every 3 to 6 seconds. Visual deterioration is apparent upon visual field testing, and optic atrophy is evident on funduscopic examination. Cerebrospinal fluid studies do not show significant pleocytosis, but oligoclonal bands of IgG are present on CSF electrophoresis. The electroencephalogram shows periodic discharges that are synchronous with the periods of myoclonus. Computed tomography (CT) of the head shows low-density white matter lesions and cerebral atrophy. At the age of 10, the boy dies. Prior infection with which of the following agents was probably related to the patient’s condition?
An 8 year old boy is taken to a pediatrician because of behavioral changes, mild intellectual deterioration, and “laziness.” Over the next several months the boy develops increasing clumsiness and periodic, involuntary, jerky movements every 3 to 6 seconds. Visual deterioration is apparent upon visual field testing, and optic atrophy is evident on funduscopic examination. Cerebrospinal fluid studies do not show significant pleocytosis, but oligoclonal bands of IgG are present on CSF electrophoresis. The electroencephalogram shows periodic discharges that are synchronous with the periods of myoclonus. Computed tomography (CT) of the head shows low-density white matter lesions and cerebral atrophy. At the age of 10, the boy dies. Prior infection with which of the following agents was probably related to the patient’s condition?
π‘ Explanation
**Core Concept**
The underlying condition being described is a progressive neurological disorder characterized by **subacute sclerosing panencephalitis (SSPE)**, which is a rare but fatal complication of a prior infection. This condition is linked to a viral infection that affects the central nervous system, leading to demyelination, inflammation, and eventual brain atrophy.
**Why the Correct Answer is Right**
The clinical presentation of SSPE, including behavioral changes, intellectual deterioration, myoclonus, visual deterioration, and the presence of oligoclonal bands of IgG in the cerebrospinal fluid, is consistent with a complication of **measles virus** infection. The measles virus can persist in the brain and cause a chronic, progressive infection that leads to the symptoms and findings described.
**Why Each Wrong Option is Incorrect**
**Option A:** Incorrect because, although other viruses can cause neurological complications, the specific pattern of SSPE is most closely associated with measles.
**Option B:** Incorrect as it is not typically linked with SSPE.
**Option C:** Incorrect because it does not match the clinical scenario described for SSPE.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that SSPE is a rare but serious complication of measles infection, emphasizing the importance of vaccination against measles to prevent such outcomes. The presence of oligoclonal bands of IgG in the cerebrospinal fluid and the characteristic clinical progression are critical for diagnosis.
**Correct Answer:** D. Measles virus.
β Correct Answer: A. Measles virus
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