Encephalomyelitis occurs in about 1:1000 cases. There appears to be no correlation between the severity of the measles and the appearance of neurologic complications. The cause of measles encephalitis is unknown . It has been suggested that early central nervous system involvement is caused by direct viral invasion of the brain. Later appearance of central nervous system symptoms is associated with demyelination and may be an immunopathologic reaction. Symptoms referable to the brain usually appear a few days after the appearance of the rash, often after it has faded. There is a second bout of fever, with drowsiness or convulsions and pleocytosis of the cerebrospinal fluid. Survivors may show permanent mental disorders (psychosis or personality change) or physical disabilities, particularly seizure disorders. The mortality rate in encephalitis associated with measles is about 10-30%, and many survivors (40%) show sequelae.
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