Objective: To assess clinical neuro-imaging diversity in children with children with subacute panencephalitis at tertiary care hospital. Methodology: Cross-Sectional Study conducted at neurology Department, National Institute of Child Health, Karachi Pakistan, from January to December 2024. Children aged 2 to 15 years were included. Demographic information, clinical features, EEG, MRI brain findings along with CSF and serum measles IgG antibodies were recorded. Results: A total of 63 children were enrolled with a mean age of 6.3±2.2years. SSPE was more common in boys 50(79.39%) patients. Mean age at presentation was 6.3years+2.2. Past history of measles was present 59 patients (93.6%), Majority have history of measles between 18- 24months of age. The latent period between measles and SSPE was 2-5years. 54 patients (85.7%) were unvaccinated while 9 patients (14.3%) were vaccinated against measles vaccination. The Clinical features at the time of presentation were in stage II 23(36.5%) and III 40(63.4%) according to modified Jabbour staging. Seven patients (11.1%) have atypical clinical presentation in the form of stroke, GBS, Kinesogenic dyskinesia, psychosis, choreiform movements and acute encephalitis. Neuroimaging was normal in majority of patients 39.6%, while gray matter changes were least common finding6.2%. Conclusion: The latency period between measles infection and disease onset can be very brief. Clinical, electroencephalographic, and radiological signs of the disease in children may be atypical. Genetic and immunologic studies are needed to establish a genetic predisposition and immunological association to the disease. Measles vaccination remains the most effective preventive measure against SSPE.