Incidence and Clinical Significances of Human T-cell Lymphotropic Virus Type I-Associated Myelopathy with T2 Hyperintensity on Spinal Magnetic Resonance Images

Yukitake, Motohiro; Takase, Yukinori; Nanri, Yasuhiro; Kosugi, Masanori; Eriguchi, Makoto; Yakushiji, Yusuke; Okada, Ryuichiro; Mizuta, Haruo; Kuroda, Yasuo

doi:10.2169/internalmedicine.47.1284

Cited by 25 publications

(25 citation statements)

References 23 publications

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“…In most cases of patients infected with HTLV-1, spinal cord MRIs are normal (58%). Atrophy of the cervical and thoracic segments are present in 34% of cases, and only 8% of cases show hyperintense lesions on the spinal cord on T2-weighted sequences, as presented in our patient 33. The incidence of brain MRI abnormalities in patients with HAM/TSP is common (25–80%).…”

Section: Discussionsupporting

confidence: 43%

HTLV-1-associated myelopathy in a solid organ transplant recipient

2016

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Human T-cell lymphotropic virus type-1 (HTLV-1) is endemic in Japan, the Caribbean and in South American countries such as Ecuador. This virus is the cause of HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP), a myelopathy characterised by chronic progressive paraparesis, spasticity and urinary symptoms. We report the case of a 40-year-old man who received a kidney transplant from a living donor and developed HAM/TSP, 24 months after transplant. The diagnosis was confirmed by detection of HTLV-1 in blood and cerebrospinal fluid by the ELISA and Western Blot tests. For myelopathy, the patient was treated with pulse methylprednisolone, but had poor response to treatment. We recommend that all patients receiving transplants and their donors who come from endemic countries be given a mandatory screening for HTLV-1 through an ELISA test, in an effort to inform candidates for renal transplantation of the potential risk of infection and the development of this disease.

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Section: Discussionsupporting

confidence: 43%

HTLV-1-associated myelopathy in a solid organ transplant recipient

2016

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“…Indirect signals of atrophy were observed in 14% of MRI of the brain and only 3% of the spinal cord. The frequency of these changes has been variable in the literature: hyperintense lesions in brain (52.4% -84%) and in spinal cord (7.9%) [16][17][18][19][20] . Atrophy of the spinal cord occurred in 20-74% of the cases.…”

Section: Discussionmentioning

confidence: 99%

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

Puccioni-Sohler

Gasparetto

Cabral‐Castro

et al. 2012

Arq. Neuro-Psiquiatr.

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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.

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“…Each type was associated with spinal swelling along with high intensity lesions, mainly located in the posterior columns, posterior horns, or lateral columns. Comparison of the clinical parameters, including the protein content, IgG level, and cell counts in the CSF of HAM/TSP patients with and without spinal lesions revealed that abnormal highintensity spinal lesions seen on T2-weighted images were reflective of active inflammation during the early stages of rapidly progressive HAM/TSP (16,18). In the present patient, fulminant myelopathy and abnormal spinal lesions detected by MRI may not be related to the early stages of HTLV-I-associated neurological manifestations.…”

Section: Discussionmentioning

confidence: 99%

Fulminant Myelopathy following Neurogenic Proximal Weakness Associated with Human T-Cell Lymphotropic Virus Type I Infection

et al. 2011

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We report a patient with human T-cell lymphotropic virus type I (HTLV-I) infection, who presented with proximal extremity neurogenic muscular weakness followed by fulminant myelopathy, but with no upper motor symptoms. The symptoms were inconsistent with the World Health Organization or El Escorial criteria for HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) or amyotrophic lateral sclerosis (ALS). This case indicates that fulminant myelopathy without upper motor neuronal symptoms may occur long after the onset of HTLV-I-associated neurogenic proximal muscular weakness. Additionally, we report that treatment with high-dose steroid pulse therapy partially improves symptoms of lightning pain and sensory disturbance.

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Incidence and Clinical Significances of Human T-cell Lymphotropic Virus Type I-Associated Myelopathy with T2 Hyperintensity on Spinal Magnetic Resonance Images

Abstract: Objective To clarify the incidence and clinical significance of HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) showing T2 hyperintensity in the spinal cord on magnetic resonance images (MRI). Patients and Methods

Cited by 25 publications

References 23 publications

HTLV-1-associated myelopathy in a solid organ transplant recipient

HTLV-1-associated myelopathy in a solid organ transplant recipient

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

Fulminant Myelopathy following Neurogenic Proximal Weakness Associated with Human T-Cell Lymphotropic Virus Type I Infection

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