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Syringohydromyelia or HTLV-I-associated myelopathy/tropical spastic paraparesis: a diagnostic challenge (case report)

Human T-cell lymphotropic virus type I (HTLV-I) associated myelopathy / tropical spastic paraparesis (HAM/TSP) is the most common chronic myelopathy in Brazil. We present the case of a 53 year old man that fulfilled the diagnostic criteria for HAM/TSP but had at the magnetic resonance imaging (MRI)...

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Published in:Arquivos de neuro-psiquiatria 1999-06, Vol.57 (2A), p.284-287
Main Authors: ARAÚJO, ABELARDO DE QUEIROZ-CAMPOS, LEITE, ANA CLAÚDIA CELESTINO BEZERRA, OLIVEIRA, ANDRÉ LUIZ DOS ANJOS DE, AFONSO, CRISTIANE RIBEIRO DE ALMEIDA, PIES, JULIANA
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Language:English
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Summary:Human T-cell lymphotropic virus type I (HTLV-I) associated myelopathy / tropical spastic paraparesis (HAM/TSP) is the most common chronic myelopathy in Brazil. We present the case of a 53 year old man that fulfilled the diagnostic criteria for HAM/TSP but had at the magnetic resonance imaging (MRI) of the spinal cord evidences of syringohydromyelia at the C6-C7 and D2-D7 levels along with Chiari type 1 malformation. The clinical picture was more typical of HAM/TSP than of syringohydromyelia, which was probably asymptomatic. The present case clearly demonstrates that serology and neuroimaging should be always used together. We conclude that, specially in places where HTLV-I is endemic, every patient with a spastic paraparesis, even with a radiological picture suggestive of a structural spinal cord lesion, should have a screening test for HTLV-I. The clinical picture must dictate the final direction of the diagnosis. Mielopatia associada ao HTLV-I / paraparesia espástica tropical (MAH/PET) é possivelmente a mielopatia crônica progressiva mais comum no Brasil. Apresentamos o caso de um homem de 53 anos que, a despeito de preencher critérios clínicos e sorológicos para MAH/PET, exibia à ressonância magnética de coluna evidências de siringo-hidromielia de níveis C6-C7 e D2-D7, além de malformação de Chiari tipo 1. Acreditamos que o quadro clínico seja devido à MAH/PET e não à siringo-hidromielia, esta, possivelmente, assintomática. Este caso demonstra que dados sorológicos e de neuroimagem devem sempre ser utilizados judiciosamente para o diagnóstico final de pacientes com suspeita de ambas as enfermidades. Concluímos que, particularmente em locais onde o HTLV-I seja endêmico, todo paciente com paraparesia espástica, mesmo com evidências radiológicas de lesão estrutural medular, deva ser submetido a avaliação sorológica para o HTLV-I. O quadro clínico deverá ser prioritário no estabelecimento do diagnóstico final.
ISSN:0004-282X
1678-4227
0004-282X
1678-4227
DOI:10.1590/S0004-282X1999000200019