Leukoencephalopathy in HTLV-I-associated myelopathy/tropical spastic paraparesis: MRI analysis and a two year follow-up study after corticosteroid therapy

Kira, Jun Ichi; Fujihara, Kazuo; Itoyama, Yasuto; Goto, Ikuo; Kanehiro, Hiromichi

doi:10.1016/0022-510x(91)90192-a

Cited by 86 publications

(45 citation statements)

References 18 publications

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“…The accuracy of the diagnosis has improved with neurophysiological tests (1,25) and with magnetic resonance imaging (MRI) (41). In the early stages of the disease, the neuroimaging of the spinal cord does not define myelopathy, although patients have signals and symptoms of upper motor neuron disease (62).…”

Section: Htlv-1-associated Myelopathy/tropical Spastic Paraparesismentioning

confidence: 99%

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Epidemiology, Treatment, and Prevention of Human T-Cell Leukemia Virus Type 1-Associated Diseases

Gonçalves

Proietti

Ribas³

et al. 2010

Clin Microbiol Rev

407

321

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SUMMARYHuman T-cell leukemia virus type 1 (HTLV-1), the first human retrovirus to be discovered, is present in diverse regions of the world, where its infection is usually neglected in health care settings and by public health authorities. Since it is usually asymptomatic in the beginning of the infection and disease typically manifests later in life, silent transmission occurs, which is associated with sexual relations, breastfeeding, and blood transfusions. There are no prospects of vaccines, and screening of blood banks and in prenatal care settings is not universal. Therefore, its transmission is active in many areas such as parts of Africa, South and Central America, the Caribbean region, Asia, and Melanesia. It causes serious diseases in humans, including adult T-cell leukemia/lymphoma (ATL) and an incapacitating neurological disease (HTLV-associated myelopathy/tropical spastic paraparesis [HAM/TSP]) besides other afflictions such as uveitis, rheumatic syndromes, and predisposition to helminthic and bacterial infections, among others. These diseases are not curable as yet, and current treatments as well as new perspectives are discussed in the present review.

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Section: Htlv-1-associated Myelopathy/tropical Spastic Paraparesismentioning

confidence: 99%

“…The high signal intensity and the contrast enhancement are located mainly in the posterior columns, posterior horns, or lateral columns at the cervical or thoracic levels (41,62). The white matter lesions can be indistinguishable from those of other demyelinating diseases (Fig.…”

Section: Htlv-1-associated Myelopathy/tropical Spastic Paraparesismentioning

confidence: 99%

Epidemiology, Treatment, and Prevention of Human T-Cell Leukemia Virus Type 1-Associated Diseases

Gonçalves

Proietti

Ribas³

et al. 2010

Clin Microbiol Rev

407

321

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“…The prevalence of these lesions is said to be around 50% to 80%, suggesting that the inflammatory response against HTLV-1 may not be restricted to the spinal cord 15 .…”

Section: Encephalopathy and Cognitive Deficitsmentioning

confidence: 99%

HTLV-1 and neurological conditions: when to suspect and when to order a diagnostic test for HTLV-1 infection?

Araújo

Leite

Lima

et al. 2009

Arq. Neuro-Psiquiatr.

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-HTLV-1 is a retrovirus associated with a myriad of clinical conditions, especially hematological and neurological ones. Regarding nervous system diseases, it is of utmost importance to select those cases in which HTLV-1 infection could really be associated. This is particularly true for patients from endemic areas and for HIV-infected patients and drug users, since that these groups are at a higher risk for HTLV infection. This caution in selecting neurological patients for HTLV diagnostic tests is justified by the fact that in some circumstances the seropositivity may merely represent an epiphenomenon. In this paper we enroll some neurological conditions that have been associated with HTLV-1/2 infection in the literature and discuss the real need for HTLV-1/2 diagnostic tests in each one. Because HIV/HTLV-co-infected patients seem to be at an increased risk for neurological diseases development, a special consideration about this matter is also made.KEy WORDs: HTLV, myelopathy, myopathy, peripheral neuropathy, HIV.doenças neurológicas e infecção pelo HTLV-1: quando suspeitar e quando solicitar testes diagnósticos para a infecção pelo HTLV-1Resumo -O HTLV-1 é um retrovírus associado tanto a doenças hematológicas quanto a doenças neurológicas. Em relação às doenças neurológicas, é fundamental que selecionemos aquelas em que de fato a infecção pelo HTLV-1 possa ser a causa. Isto é particularmente verdadeiro nos pacientes oriundos de áreas endêmicas e nos pacientes infectados pelo HIV e usuários de drogas, haja vista que estes grupos são de risco para infecção pelo HTLV. Este cuidado ao selecionarmos aquelas condições neurológicas que merecem ser investigadas com sorologia para o HTLV se justifica pelo fato de que nem sempre podemos afastar uma associação fortuita entre a infecção e a referida doença. Neste artigo, comentaremos sobre algumas condições neurológicas que podem estar associadas com a infecção pelo HTLV-1/2, discutindo a real necessidade de solicitar testes para o diagnóstico da infecção pelo HTLV-1/2 frente a elas. Uma breve consideração sobre a co-infecção HIV/ HTLV será feita no final deste artigo tendo em vista que estes pacientes apresentam um risco aumentado para o desenvolvimento de doenças neurológicas.PALAVRAs-CHAVE: HTLV, mielopatia, miopatia, neuropatia periférica, HIV.The human T cell lymphotropic virus type 1 (HTLV-1) is a retrovirus and the etiologic agent of both a group of hematological disorders known as Adult T cell leukemia/ lymphoma (ATLL) 1 and a group of neurological conditions known altogether as the HTLV-1 neurological complex 2 , of which the most common is the HTLV-1 associated myelopathy/Tropical spastic paraparesis (HAM/TsP) 3 . Endemic infection with HTLV-1 is now recognized to be worldwide, and is also common in Brazil 4 . The number of people around the world infected with HTLV-1 is estimated as being between 10 to 20 million. There are areas in Japan, sub-saharan Africa, the Caribbean, and south America where more than 1% of the general population is infected. T...

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“…11,13 No studies have examined HTLV-I carriers without indications for MRI. Moreover, no studies have tried to correlate immunological measures with WM lesions.…”

Section: Introductionmentioning

confidence: 99%

Brain Magnetic Resonance Imaging White Matter Lesions Are Frequent in HTLV-I Carriers and Do Not Discriminate from HAM/TSP

Morgan

Caskey

Abbehusen³

et al. 2007

AIDS Research and Human Retroviruses

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Human T lymphotropic virus (HTLV)-I is known to cause HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and other pronounced disease in less than 4% of those infected. However, evidence is accumulating that a proportion of HTLV-I carriers have neurological and urological symptoms without fulfilling criteria for HAM/TSP. Brain white matter (WM) lesions on magnetic resonance imaging (MRI) are frequently seen in HAM/TSP. HTLV-I carriers with MRI scans for other neurological diagnoses have WM lesions more frequently than expected. We studied 10 patients with HAM/TSP and 20 HTLV-I carriers without overt neurological disease and evaluated clinical characteristics, viral load, total, small, large, confluent WM lesion number, and lesion volume on MRI. Cerebral WM lesions were found in of 85% of HTLV-I carriers and 80% of HAM/TSP patients. Lesion number, size or location was no different between carriers and HAM/TSP. Cognitive function was lower in HAM/TSP (p = 0.045) but did not correlate with WM lesion number. Viral load and peripheral blood mononuclear cell interferon-γ production correlated positively (p = 0.001) but did not correlate with lesion number or volume. Conventional brain MRI frequently shows WM lesions in HTLV-I-infected individuals suggesting potential early central nervous system inflammation with rare development of progressive disease.

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Leukoencephalopathy in HTLV-I-associated myelopathy/tropical spastic paraparesis: MRI analysis and a two year follow-up study after corticosteroid therapy

Cited by 86 publications

References 18 publications

Epidemiology, Treatment, and Prevention of Human T-Cell Leukemia Virus Type 1-Associated Diseases

Epidemiology, Treatment, and Prevention of Human T-Cell Leukemia Virus Type 1-Associated Diseases

HTLV-1 and neurological conditions: when to suspect and when to order a diagnostic test for HTLV-1 infection?

Brain Magnetic Resonance Imaging White Matter Lesions Are Frequent in HTLV-I Carriers and Do Not Discriminate from HAM/TSP

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