| Abstract | dc.description.abstract | Background: The spastic paraparesis associated to HTLV-1 causes
degenerative pyramidal tract lesions of the spinal cord and affects cortical-nuclear connections in the
brain. Aim: To report the findings of magnetic resonance imaging in patients with spastic paraparesis.
Material and methods: A magnetic resonance imaging of the brain and spinal cord was performed
in 30 patients (24 females), mean age and evolution of 56 and 12 years respectively, with a clinical
and virological diagnosis of tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM).
Results: No patient had abnormal signals in the spinal cord parenchyma. However, an atrophy of the
dorsal segment was observed in 87% of patients. Patients with the highest degree of atrophy showed a
higher degree of functional impairment. Eleven patients had spinal cord conus atrophy, associated to
neurogenic bladder or impotency. In 80% of patients, hyperintense subcortical white matter images in
DP, T2 and Flair, mostly bi frontal, were detected. In half of them, small rounded and isolated images
were observed. In the other half, eight or more images, generally larger and occasionally confluent,
were found. Ten of 12 patients with confluent brain lesions showed different degrees of cognitive
impairment. No patient had lesions in the corpus callosus, periventricular white matter, pons, medulla
oblongata or cerebellum. Conclusions: Most patients with tropical spastic paraparesis have alterations
in brain or spinal cord magnetic resonance imaging. The magnetic resonance lesions are concordant
with functional impairment. The characteristics of the imaging in TSP/HAM patients can be helpful in
the differential diagnosis of patients with paraparesis. | en |
