Myelopathies in HIV Infection

  • R. J. Guiloff

Abstract

Myelopathies are seen clinically in about 7% of AIDS cases (McArthur 1987; Guiloff et al. 1988) and pathologically in 40%–50% of AIDS post mortems (Henin et al. 1992) but they are far less frequent in children (Sharer et al. 1990). The commonest is vacuolar myelopathy, an entity of unknown aetiology. Other myelopathies include infection by HIV-1, opportunistic infections, tumours, vascular lesions and myelopathies unrelated to HIV disease. Overall these other myelopathies are, as a group, as frequent as vacuolar myelopathy. Reasons for the lower clinical than pathological incidence include coexisting peripheral nerve or intracranial disease masking the signs of myelopathy, absence of clinical signs in cases with mild or moderate pathological change and failure to make the clinical diagnosis of vascular myelopathy in cases without weakness or spasticity or without the typical combination of pyramidal and posterior column signs.

Keywords

Dementia Neurol Aspergillus Vasculitis Encephalitis 

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References

  1. Berger JR (1992) Spinal cord syphilis associated with human immunodeficiency virus infection: a treatable myelopathy. Am J Med 92:101–103PubMedCrossRefGoogle Scholar
  2. Britton CB, Mesa-Tejada R, Fenoglio CM, Hays AP, Garvey GG, Miller JR (1985) A new complication of AIDS: thoracic myelitis caused by herpes simplex virus. Neurology 35:1071–1074PubMedCrossRefGoogle Scholar
  3. Budka H, Maier H, Pohl P (1988) Human immunodeficiency virus in vacuolar myelopathy of the acquired immunodeficiency syndrome. N Engl J Med 319:1667–1668PubMedCrossRefGoogle Scholar
  4. Chretien F, Gray F, Lescs MC et al. (1993) Acute varicella-zoster virus ventriculitis and meningo-myelo-radiculitis in acquired immunodeficiency syndrome. Acta Neuropathol 86:659–665PubMedCrossRefGoogle Scholar
  5. Cohen BA, McArthur JC, Grohman S, Patterson B, Glass JD (1993) Neurologic prognosis of cytomegalovirus polyradiculomyelopathy in AIDS. Neurology 43:493–499PubMedCrossRefGoogle Scholar
  6. de Gans J, Portegies P, Tiessens G, Troost D, Danner SA, Lange JM (1990) Therapy for cytomegalovirus polyradiculomyelitis in patients with AIDS: treatment with ganciclovir. Aids 4:421–425PubMedCrossRefGoogle Scholar
  7. Denning DW, Anderson J, Rudge P, Smith H (1987) Acute myelopathy associated with primary infection with human immunodeficiency virus. Br Med J 294:143–144CrossRefGoogle Scholar
  8. Devinsky O, Cho E-S, Petito CK, Price RW (1991) Herpes zoster myelitis. Brain 114:1181–1196PubMedCrossRefGoogle Scholar
  9. Dickson DW, Belman AL, Park YD et al. (1989) Central nervous system pathology in pediatric AIDS: an autopsy study. APMIS Suppl. 8:40–57PubMedGoogle Scholar
  10. Dodson D (1990) Transverse myelitis and spastic paraparesis in a patient with HIV infection. N Engl J Med 322:1322PubMedGoogle Scholar
  11. Fairley CK, Wodak J, Benson E (1992) Spinal cord toxoplasmosis in a patient with human immunodeficiency virus infection. Int J STD AIDS 3:366–368PubMedGoogle Scholar
  12. Fenelon G, Gray F, Scaravilli F et al. (1991) Ischaemic myelopathy secondary to disseminated intravascular coagulation in AIDS. J Neurol 238:51–54PubMedCrossRefGoogle Scholar
  13. Fuller GN, Gill SK, Guiloff RJ et al. (1990) Ganciclovir for lumbosacral polyradiculopathy in AIDS. Lancet 335:48–49PubMedCrossRefGoogle Scholar
  14. Geny C, Gherardi R, Boudes P, Lionnet F, Cesaro P, Gray F (1991) Multifocal multinucleated giant cell myelitis in an AIDS patient. Neuropathol Appl Neurobiol 17:157–162PubMedCrossRefGoogle Scholar
  15. Goldstick L, Mandybur TI, Bode R (1985) Spinal cord degeneration in AIDS. Neurology 35:103–106PubMedCrossRefGoogle Scholar
  16. Grafe MJ, Wiley CA (1989) Spinal cord and peripheral nerve pathology in AIDS: the roles of cytomegalovirus and human immunodeficiency virus. Ann Neurol 25:561–566PubMedCrossRefGoogle Scholar
  17. Guiloff RJ, Fuller GN, Roberts A et al. (1988) Nature, incidence and prognosis of neurological involvement in the acquired immunodeficiency syndrome in central London. Postgrad Med J 64:919–925PubMedCrossRefGoogle Scholar
  18. Harris TM, Smith RR, Bognanno JR, Edwards MK (1990) Toxoplasmic myelitis in AIDS: gadolinium-enhanced MR. J Comput Assist Tomogr 14:809–811PubMedCrossRefGoogle Scholar
  19. Henin D, Smith TW, De Girolami U, Sughayer M, Hauw JJ (1992) Neuropathology of the spinal cord in the acquired immunodeficiency syndrome. Hum Pathol 23:1106–1114PubMedCrossRefGoogle Scholar
  20. Herskovitz S, Siegel SE, Schneider AT, Nelson SJ, Goodrich JT, Lantos G (1989) Spinal cord toxoplasmosis in AIDS. Neurology 39:1552–1553PubMedCrossRefGoogle Scholar
  21. Horoupian DS, Pick P, Spigland I et al. (1984) Acquired immune deficiency syndrome and multiple tract degeneration in a homosexual man. Ann Neurol 15:502–505PubMedCrossRefGoogle Scholar
  22. Kamin SS, Petito CK (1991) Idiopathic myelopathies with white matter vacuolation in non-acquired immunodeficiency syndrome patients. Hum Pathol 22:816–824PubMedCrossRefGoogle Scholar
  23. Kayser C, Campbell R, Sartorious C, Bartlett M (1990) Toxoplasmosis of the conus medullaris in a patient with hemophilia A-associated AIDS. Case report. J Neurosurg 73:951–953PubMedCrossRefGoogle Scholar
  24. Klein P, Zientek G, VandenBerg SR, Lothman E (1990) Primary CNS lymphoma: lymphomatous meningitis presenting as a cauda equina lesion in an AIDS patient. Can J Neurol Sci 17:329–331PubMedGoogle Scholar
  25. Lanska MJ, Lanska DJ, Schmidley JW (1988) Syphilitic polyradiculopathy in an HIV-positive man. Neurology 38:1297–1301PubMedCrossRefGoogle Scholar
  26. Leger JM, Henin D, Belec L et al. (1992) Lymphoma-induced polyradiculopathy in AIDS: two cases. J Neurol 239:132–134PubMedCrossRefGoogle Scholar
  27. Mahieux F, Gray F, Fenelon G et al. (1989) Acute myeloradiculitis due to cytomegalovirus as the initial manifestation of AIDS. J Neurol Neurosurg Psychiatry 52:270–274PubMedCrossRefGoogle Scholar
  28. Maier H, Budka H, Lassmann H, Pohl P (1989) Vacuolar myelopathy with multinucleated giant cells in the acquired immune deficiency syndrome (AIDS). Light and electron microscopic distribution of human immunodeficiency virus (HIV) antigens. Acta Neuropathol 78:497–503PubMedCrossRefGoogle Scholar
  29. McArthur JC (1987) Neurologic manifestations of AIDS. Medicine 66:407–437PubMedCrossRefGoogle Scholar
  30. McArthur JC, Griffin JW, Cornblath DR et al. (1990) Steroid-responsive myeloneuropathy in a man dually infected with HIV-1 and HTLV-I. Neurology 40:938–944PubMedCrossRefGoogle Scholar
  31. Mehren M, Burnes PJ, Mamani F, Levy CS, Laureno R (1988) Toxoplasmic myelitis mimicking intramedullary spinal cord tumour. Neurology 38:1648–1650PubMedCrossRefGoogle Scholar
  32. Melhem ER, Wang H (1992) Intramedullary spinal cord tuberculoma in a patient with AIDS. Am J Neuroradiol 13:986–988PubMedGoogle Scholar
  33. Miller RG, Storey JR, Greco CM (1990) Ganciclovir in the treatment of progressive AIDS-related polyradiculopathy. Neurology 40:569–574PubMedCrossRefGoogle Scholar
  34. Moskowitz LB, Hensley GT, Chan JC, Gregorios J, Conley FK (1984) The neuropathology of acquired immune deficiency syndrome. Arch Pathol Lab Med 108:867–872PubMedGoogle Scholar
  35. Overhage JM, Greist A, Brown DR (1990) Conus medullaris syndrome resulting from Toxoplasma gondii infection in a patient with the acquired immunodeficiency syndrome. Am J Med 89:814–815PubMedCrossRefGoogle Scholar
  36. Petito CK, Navia BA, Cho ES, Jordan BD, George DC, Price RW (1985) Vacuolar myelopathy pathologically resembling subacute combined degeneration in patients with the acquired immunodeficiency syndrome. N Engl J Med 312:874–879PubMedCrossRefGoogle Scholar
  37. Petito CK, Vecchio D, Chen YT (1994) HIV antigen and DNA in AIDS spinal cords correlate with macrophage infiltration but not with vacuolar myelopathy. J Neuropathol Exp Neurol 53:86–94PubMedCrossRefGoogle Scholar
  38. Poon TP, Tchertkoff V, Pares GF, Masangkay AV, Daras M, Marc J (1992) Spinal cord toxoplasma lesion in AIDS: MR findings. J Comput Assist Tomogr 16:817–819PubMedCrossRefGoogle Scholar
  39. Rance NE, McArthur JC, Cornblath DR, Landstrom DL, Griffin JW, Price DL (1988) Gracile tract degeneration in patients with sensory neuropathy and AIDS. Neurology 38:265–271PubMedCrossRefGoogle Scholar
  40. Rhodes RH, Ward JM (1989) Immunohistochemistry of human immunodeficiency virus in the central nervous system and an hypothesis concerning the pathogenesis of AIDS meningoencephalomyelitis. Progr Aids Pathol 1:167–179Google Scholar
  41. Rosenblum MK, Brew BJ, Hahn B et al. (1992) Human T-lymphotropic virus type I-associated myelopathy in patients with the acquired immunodeficiency syndrome. Hum Pathol 23:513–519PubMedCrossRefGoogle Scholar
  42. Sharer LR, Dowling PC, Michaels J et al. (1990) Spinal cord disease in children with HIV-1 infection: a combined molecular biological and neuropathological study. Neuropathol Appl Neurobiol 16:317–331PubMedCrossRefGoogle Scholar
  43. Snider WD, Simpson DM, Nielsen S, Gold JW, Metroka CE, Posner JB (1983) Neurological complications of the acquired immune deficiency syndrome: analysis of 50 patients. Ann Neurol 14:403–418PubMedCrossRefGoogle Scholar
  44. Tan SV, Guiloff RJ, Scaravilli F (1995) AIDS-associated vacuolar myelopathy. A morphometric study. Brain 118:1247–1261PubMedCrossRefGoogle Scholar
  45. Tan SV, Guiloff RJ, Henderson DC et al. (1996) AIDS-associated vacuolar myelopathy and tumor necrosis factor-alpha (TNFa). J Neurol Sci 138:134–144PubMedCrossRefGoogle Scholar
  46. Tucker T, Dix RD, Katzen C, Davis RL, Schmidley JW (1985) Cytomegalovirus and herpes simplex virus ascending myelitis in a patient with acquired immune deficiency syndrome. Ann Neurol 18:74–79PubMedCrossRefGoogle Scholar
  47. Tyor WR, Glass JD, Baumrind N et al. (1993) Cytokine expression of macrophages in HIV-1-associated vacuolar myelopathy. Neurology 43:1002–1009PubMedCrossRefGoogle Scholar
  48. Vinters HV, Guerra WF, Eppolito L, Keith PE (1988) Necrotizing vasculitis of the nervous system in a patient with AIDS-related complex. Neuropathol Appl Neurobiol 14:417–424PubMedCrossRefGoogle Scholar
  49. Vinters HV, Kwok MK, Ho HW et al. (1989) Cytomegalovirus in the nervous system of patients with the acquired immune deficiency syndrome. Brain 112:245–268PubMedCrossRefGoogle Scholar
  50. von Einsiedel RW, Fife TD, Aksamit AJ et al. (1993) Progressive multifocal leukoencephalopathy in AIDS: a clinicopathologic study and review of the literature. J Neurol 240:391–406CrossRefGoogle Scholar
  51. Woods GL, Goldsmith JC (1990) Aspergillus infection of the central nervous system in patients with acquired immunodeficiency syndrome. Arch Neurol 47:181–184PubMedCrossRefGoogle Scholar
  52. Woolsey RM, Chambers TJ, Chung HD, McGarry JD (1988) Mycobacterial meningomyelitis associated with human immunodeficiency virus infection [see comments]. Arch Neurol 45:691–693PubMedCrossRefGoogle Scholar

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© Springer-Verlag London 1997

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  • R. J. Guiloff

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