Acute Myelopathy or Cauda Equina Syndrome in HIV-Positive Adults in a Tuberculosis Endemic Setting: MRI, Clinical, and Pathologic Findings

Abstract

BACKGROUND AND PURPOSE:Cape Town is the center of an HIV-tuberculosis coepidemic. This study's aim was to highlight the importance and to describe the MR imaging features of tuberculosis in acute myelopathy and cauda equina syndrome in HIV-positive adults. To accomplish this we retrospectively reviewed the MR imaging and clinico-pathologic findings of HIV-positive patients presenting to our hospital with recent onset paraplegia and sphincter dysfunction over a 4-year period, 2008 -2011.

Differential diagnosis and treatment of acute cauda equina syndrome in the human immunodeficiency virus positive patient: a case report and review of the literature

“…When this occurs, it is often caused by CNS infection that affects the cauda equina or conus medullaris. CMV and MTB are the most common infectious causes among HIV-positive patients [ 5 , 13 , 14 ], which can be in the context of concurrent infection of the retina and other organs [ 2 , 13 ].…”

“…In the full-blown syndrome, the patient may present with sensory loss of the lower body’s dorsal surface, bilateral sciatic nerve pain, paresthesia, decreased strength of the lower limbs or chronic flaccid paraplegia, absence of deep tendon reflexes, and bladder/sphincter dysfunction [ 1 ]. Lymphomas have also been reported to cause CES in HIV-positive patients [ 5 , 23 ]. Finally, primary CES in these patients is a benign, idiopathic form of the syndrome that has a slow clinical progression, mild neurologic deficits, and a generally better prognosis, which may explain those cases where no anatomical causes, infectious agents or neoplastic cells can be identified [ 24 ].…”

“…Numerous causes of CES have been reported to date, including spinal disk herniation, trauma, spinal stenosis, iatrogenic causes, neoplasms, ischemia, inflammation, and infections [ 1 ]; an etiology for a portion of cases cannot be identified. In patients with advanced human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), central nervous system (CNS) infections, usually due to cytomegalovirus (CMV) or Mycobacterium tuberculosis (MTB), comprise the most common causes of CES [ 2 – 5 ]. However, noninfectious processes may also lead to CES in individuals infected with HIV, especially when the disease is well controlled, as in the case report that follows.…”

Manifestaciones Neurológicas en Pacientes Ambulatorios con Diagnóstico de VIH Atendidos en el Hospital Carlos Andrade Marín.

“…metástasis, tuberculosis) y no compresivas (ej. mielitis, paraparesia espástica tropical, mielopatía vacuolar) basados en la urgencia del manejo [33,34]; se estima que la mielopatía vacuolar afecta a un tercio de los portadores del VIH y causa molestias relevantes al 1-5% [35]. Los estudios neurofisiológicos han detectado Tabla 2.…”

Distal cord-predominant longitudinally extensive myelitis with diffuse spinal meningitis and dural abscesses due to occult tuberculosis: A rare occurrence

“…Among patients of HIV-TB coinfection, 30% had myelitis/arachnoiditis, and the most common cause of myelopathy/cauda equina in HIV patients was TB. [ 4 ] We present one such case of infective distally LETM due to TB unrelated to HIV.…”