Poster Abstracts Wednesday, November 9, 2005 $309

Conclusion: Although the positive results were more in 2 l'a week and more in severe palsies, but a significant relationship between Bell's palsy or its severity and positive PCR for HSV was not detected (P value > 0.05).

0818 Tuberculous mastoiditis associated with facial paralysis in kidney retransplant

Hernandez Fustes, O ~, Mouchaileh, G L~, Rodrigues, p3, Ziger, F 2, Macarirfi, L 1"2. llnNeuro, Hospital Pilaf, UTP," 2Hospital Univ Cajuru," 3PUC-P.R

The mastoiditis is a complication of the medium otifis characterized by supuration and destruction of the mastoides cells and the pyramid petrosa; its tuberculous etiology decreasing in the last 40 years. The coming paralysis of tiffs is more common in children. Its incidence rises in; even so, there are not in the literature reports associated to it renal transplants. We told the a patient's case in the 71st day of renal retransplant of living donor related, in immunosuppressive therapy use that developed paralysis of the 7th cranial nerve associated with tuberculous mastoiditis.

The mastoiditis diagnosis is clinical-radiologic, being the axial tomography the election exam. The paralysis of the facial nerve happens for the easy destruction of the bony capsule that involves it. The treatment when done precoceous with chemotherapy avoids the surgical procedure. With that should stand back the tuberculous etiology in a mastoiditis, especially in immunocompromised patient.

0819 Tile role of SPECT with I23I-IMP in tile diagnosis of Creutzti~ldt-Jakob Disease

Ishida, S, Sugino, M, Hosokawa, T, Satoh, T, Fujimura, C, Nakajima, H, Furutama, D, Kirnura, F, Hanafusa, T. First Department Of Internal Medicine, Osaka Medical College

Baekgrouml: Although the diagnosis of Creutzfeldt-Jacob disease (CJD) is straightforward in fully developed cases, a definitive diagnosis can be difficult early in the course of the illness. Methods: We performed brain snigle-photon emission tomography (SPECT) using N-isopropyl-p-[l23I] iodoamphetanffne (IMP) as a tracer in the early stage of seven patients with CJD, and evaluate the clinical usefulness of SPECT in relation to the clinical symptoms and MRI findings of CJD. Results: Two patterns of the distribution of regional cerebral blood flow (rCBF) on SPECT were observed; the first, a reduced uptake of the tracer in the cerebral cortex, sometimes in an asymmetric pattern, and preserved in the thalanms, basal ganglia and cerebellum (Group A), the second, a severely decreased uptake throughout the brain, including the thalamus, basal ganglia and cerebellum (Group B). Clinical symptoms were mild including cerebellar atmxia in all patients of group B, whereas many of group A patients were bedridden state. In patients of group B, there was small area of abnomml signal intensities on diffusion-weighted M R images. The cause of these discrepant findings between SPECT and diffusion-weighted MRI in patients of group B was speculated that dysfunction of the thalamo-cortical projection systems by the thalamic lesions might result in reduced rCBF developed diffuse brain hypoperfusion. Conclusion: The two hypoperfusion patterns in SPECT imaging were observed in early phase of CJD. Each finding showed different clinical picture and might reflect the varied expanse of pathology of CJD. These findings suggest that brain SPECT provide useful information in considering the disease mechanism of CJD.

0820 Coinparafive pathogenesis of reeoinbinant rabies vacdne strain SAD-L16 and SAD-D29 with replacement of Arg333 in the glycoprotein after peripheral inoculation of neonatal mice

Jackson, AC, Rasalingam, P, Weli, SC. Queen's University, Kingston, Ontario, Canada

Background: Rabies virus causes an acute encephalomyelitis in humans and alffmals. The mouse model is an important tool in understanding the pathogenesis of rabies. Method: A comparative study was performed in two-day-old ICR mice inoculated in a hindlimb thigh muscle with recombinant rabies virus vaccine strain SAD-LI6 (L16) or SAD-D29 (D29), which contains an attenuating substitution of Arg333 in the glycoprotein. Histopatholo- gical and inmmnolffstochemical analyses of brains were performed at early daily time points and in moribund ammals. Results: Both viruses caused progressive limb weakness; mortality with LI6 was 100% at day 7 post-inoculation (p.i.) and 75% at 17 days p.i. for D29 and Kaplan-Meyer survival curves were significantly different. L16 spread to the brain more quickly than D29, and both viruses produced multifocal lesions in the brainstem tegmentum and cerebellum (deep cerebellar nuclei and internal granular layer) associated with inflammatory changes and neuronal apoptosis. There was more disseminated involvement of the brain and many more infected neurons in LI6 infection, particularly in the neostriatum, hippocampus, and cerebral cortex. In light of the lower burden of infection and smaller number of neurons infected with D29, tiffs less virulent virus was a stronger inducer of neuronal apoptosis than the more virulent LI6. Conclusion: These findings support previous in vitro studies indicating that there is an inverse relationship between pathogenicity and apoptosis. Induction of apoptosis, wlffch is an innate mechalffsm by which the host restricts viral spread, may contribute to severe clinical neurological disease when there is viral invasion into the CNS.

0821 Experience with Subacute Sderosing Panencephalifis (SSPE) in The Child Development and Neurology Unit of Dhaka Shishu (Children's) Hospital, Bangladesh

Jahan A, Azam MM, Majumdar S, Banu SH, Khan NZ. Dhaka Shishu (Children's) Hospital, Dhaka, Bangladesh

Background: Successful vaccination progranm~e brought dramatic changes in under five childhood mortality in Bangladesh, a developing country. Vaccination coverage for DPT and Polio is over 85%. For measles vaccination it is only about 77?,';. For the last few years neurology unit o f Dhaka children's hospital is fighting with the dreadful untreatable chronic illness of measles virus encephalitis, SSPE. We are just the helpless observer of its pathetic ending. Method: This is a prospective case study of the children with SSPE got admitted in our department from July 2002 till date. Results: Total 21 children were admitted with SSPE. The male:female ratio was 3.2:1. The age range was 1 yr 11 months to 13 yrs. The mean age was 6.9 yrs. Mean duration of the illness was 3.6 months. Most of them were presented in the third stage of the disease. 19 (90.1"/o) developed the illness acutely. 16 (176%) of children suffered from the illness despite vaccination at the fight time. CSF measles antibody titre for IgM was found high in 15 (171%) o f the cases. Characteristic. EEG finding was present in 9 (42.3%) of clffldren. Outcome was grave in every case. Conclusions: SSPE can occur after vaccination. But prevalence is much low. We are worried whether vaccination failure, because of incorrect preparation or preservation or other factors cause the disease in Bangladesh. This should immediately be sorted out, but it is difficult for our country. World wide research is needed to halt or to cure tiffs dreadful illness, the outcome of which is always fatal.

0822 Cllll[Cal spe~truiil~ pitfllUs in diagnosis and therapeutic implications in Herpes Simplex encephalitis