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Images in Neurology
July 2004

Spinal Cord Swelling in Human T-Lymphotropic Virus 1–Associated Myelopathy/Tropical Spastic Paraparesis: Magnetic Resonance Indication for Early Anti-inflammatory Treatment?

Arch Neurol. 2004;61(7):1134-1135. doi:10.1001/archneur.61.7.1134

In February 1998, a 43-year-old Brazilian man developed a rapidly progressive spastic paraparesis. Cerebrospinal fluid findings showed a mild inflammatory response, with 21 leukocytes/mm3, 240 mg/dL of protein, and an intrathecal immune production of anti–human T-lymphotropic virus 1 (HTLV-1) antibodies. Subsequently, a positive HTLV-1 serological finding was also confirmed. A magnetic resonance (MR) image of the spine revealed thoracic cord edema, along with several foci of contrast-enhanced lesions (Figure 1). The patient was given interferon alfa for 1 month and referred to our center in July 1998. At that point he was wheelchair bound, and results of his neurological examination revealed a flaccid paraparesis, hyporeflexia in the lower limbs, a left Babinski sign, and loss of vibration sense in the legs. In September 1998, a new MR image showed only thoracic cord atrophy with disappearance of all enhanced lesions (Figure 2). At that time, the patient was able to walk with a walking stick, and the initial flaccid deficit was replaced with a spastic paraparesis, with hyperreflexia, and a distal sensory loss.

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