HAM/TSP: association between white matter lesions on magnetic resonance imaging, clinical and cerebrospinal fluid findings

Abstract

OBJECTIVE: To investigate the association between clinical data, white matter lesions and inflammatory cerebrospinal fluid (CSF) findings in HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). METHOD: We studied brain and cervical spinal cord on magnetic resonance imaging (MRI) and CSF examinations of 28 Brazilian HAM/TSP patients. RESULTS: The majority of patients had severe neurological incapacity with EDSS median of 6.5 (3-8). The brain MRI showed white matter lesions (75%) and atrophy (14%). The preferential brain location was periventricular. Cervical demyelination lesions occurred in 11% of the cases, and cervical atrophy in 3.5%. One patient had enhancement lesions on T1 cervical spinal cord MRI. Cases with spinal cord lesions had signs of acute CSF inflammation. The brain white matter lesions predominated in the patients with higher age. CONCLUSION: Our data suggest that an active inflammatory process is associated with the cervical spinal cord lesions in HAM/TSP. The brain abnormalities are not related to the clinical picture of HAM/TSP.

Clinical and laboratory features of HTLV-I asymptomatic carriers and patients with HTLV-I-associated myelopathy/tropical spastic paraparesis from the Brazilian Amazon

“…Among our HAM/TSP patients, most showed small lesions in the subcortical and periventricular WM, however these lesions were not associated with symptoms, as reported 45 , 46 . MRI findings of 28 Brazilian HAM/TSP patients, mostly with severe neurological incapacity, showed hyper intense lesions in brain WM, indirect atrophy signs and occasionally spinal cord lesions 44 . Among our HAM/TSP patients, no sign of spinal cord swelling was reported, whereas only one patient showed spinal cord atrophy, however variable levels of spinal cord abnormalities have been reported 46 , 47 .…”

“…Unspecific periventricular and subcortical white matter (WM) lesions on brain MRI are frequent in HAM/TSP patients 41 . It has been suggested that WM lesions may represent small vessel vasculitis and since they predominate in middle aged/older patients, they could be due to degenerative microangiopathy 43 , 44 . Among our HAM/TSP patients, most showed small lesions in the subcortical and periventricular WM, however these lesions were not associated with symptoms, as reported 45 , 46 .…”

Multidisciplinary Approach to Tropical and Subtropical Infectious Diseases: Imaging with Pathologic Correlation

“…22 Human T-cell lymphotropic virus 1 neurologic complex has been described as an iceberg model, with human T lymphotropic-associated myelopathy and/or tropical spastic paraparesis forming its tip, which develops in 2%-4% of the infected population. 23,24 The diagnosis is confirmed by detecting antihuman T-cell lymphotropic virus 1 antibodies in CSF and serum. Although the exact mechanism of CNS disease is unknown, it has been postulated to be due to direct viral invasion and/or autoimmune mechanisms that result in brain and spinal cord infiltration by lymphocytes and monocytes that involve the gray and white matter.…”

Conference Highlights of the 16th International Conference on Human Retrovirology: HTLV and Related Retroviruses, 26–30 June 2013, Montreal, Canada

“…Eradication of HTLV might be possible by elimination of infected monocytes and through allogeneic hematopoietic stem cell transplantation [18]. CNS imaging has advanced so that asymptomatic carriers may be distinguished from patients with early HAM/TSP [19]. New imaging techniques were presented which could potentially be used to also measure and monitor treatment response.…”