Presentation
5 months slowly progressing chronic spastic paraparesis. Bowel and bladder dysfunction.
Patient Data
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The spinal cord shows longitudinal hyperintensity and swelling of the thoracic segment on sagittal T2-weighted images.
On axial T2-weighted, the dorsal cord exhibits signal hyperintensity in the lateral columns.
This finding is highly specific for HTLV-1-associated myelopathy.
Immunomicrobiology
- HTLV-I antibodies: positive
- HTLV IgG (ELISA): positive
Case Discussion
The findings are consistent with HTLV-1-associated myelopathy. The longitudinal involvement circumscribed to the lateral columns is specific to this entity.
This patient was a native of Lima (Peru) who had been living in Europe for four years.
Despite the fact that this type of infection is very rare in Europe, as well as its impact on the CNS, the myelopathy pattern and the patient's epidemiological context led to suspect HTLV-1.
The immunological study confirmed the diagnosis.
There is currently no specific treatment for this disease. Treatment is usually based on immunomodulators (steroids, plasmapheresis, pentoxifylline and interferon).
Differential diagnosis
Given the infrequency of this entity, spinal cord infarction, NMO and transverse myelitis were considered as possible alternative diagnoses at first.
Key Learning Points
- The MRI finding of extensive longitudinal myelopathy encompasses a broad differential diagnosis; if there is circumscribed involvement of the lateral columns of the medulla and cord, the diagnosis of HTLV-1 myelopathy should be considered
- Radiological control is recommended to assess the possible residual atrophy
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