HIV-associated vacuolar myelopathy: A rare initial presentation of HIV

Abstract

HIV-associated vacuolar myelopathy, or AIDS-associated myelopathy, is a rare initial presentation of HIV. One of the common HIV-associated neurocognitive disorders, HIV-associated vacuolar myelopathy presents with advanced immunosuppression in patients and is frequently associated with dementia. However, most cases are subclinical with characteristic findings identified through physical examination and/or imaging modalities. HIV-associated vacuolar myelopathy is characterized by progressive spastic paraparesis, gait disturbance and lower extremity sensory abnormalities including vibratory sensation. Magnetic resonance imaging findings in the spinal cord are abnormal in some patients with HIV-associated myelopathy, characteristically showing spinal cord atrophy at the level of the thoracic spine, but they may also be normal. Unfamiliarity with this as initial presentation of HIV infection may lead to failure to diagnose and intervene appropriately. We present a case of newly diagnosed HIV with myelopathy and dementia with minimal spinal cord involvement on magnetic resonance imaging.

Glutathione in HIV-Associated Neurocognitive Disorders

“…As the condition is rare and hard to diagnose at an appropriate time due to its similar presentation to the subacute combined degeneration seen in B12 deficiency, case reports provide valuable information. In one case report of a 34-year-old man who experienced cognitive changes, spasticity, gait dysfunction, and urinary incontinence, the initiation of ART resulted in improved cognitive changes but no improvements to spasticity or urinary incontinence [ 121 ]. A case report in India in 2020 described the treatment of vacuolar myelopathy with IVIG, resulting in the resolution of spastic paresis and sensory processing disorders with a retained Babinski’s sign [ 122 ].…”

Correlation of Vitamin B12 and D with Neurocognitive Function in HIV/AIDS Patients in H. Adam Malik General Hospital Medan

“…(20) In advanced immunosuppression is more commonly reported with neurocognitive disorders especially HAD. (21) Dementia is a clinical manifestation in 4-15% of patients with HAND. (22) This study did not show a significant correlation between vitamin B12 and neurocognitive function based on MMSE or MoCA-Ina scores but some studies showed the importance of vitamin B12 in this condition, there is a methylation reaction disorder that causes neurological and psychological dysfunction.…”

Neurologic Complications of Human Immunodeficiency Virus

“…As with HIV-associated dementia, ART is the mainstay of therapy. Although there is limited benefit in slowing progression once this condition has developed, cases of improvement have been reported 42,43 …”

“…Although there is limited benefit in slowing progression once this condition has developed, cases of improvement have been reported. 42,43 COMPARTMENTALIZED CENTRAL NERVOUS SYSTEM INFECTION (CSF ESCAPE). CSF escape refers to the presence of ongoing viral replication within the CNS despite relative virologic suppression in the blood with ART use.…”