Synonyms: HTLV-1-assocaited myelopathy (HAM), HAM/TSP
Clinical features:
(1) chronic meningomyelitis of the spinal cord
(2) slowly progressive spastic paraparesis that does not show remissions
(3) weakness of the lower extremites progressing to gait impairment
(4) pain in the lumbar region
(5) neuropathic symptoms of tingling, burning and pins-and-needles
(6) autonomic dysfunction of the urinary bladder and bowel with incontinence and sexual dysfunction
(7) results in significant disability
The CSF shows a lymphocytic pleocytosis. Oligoclonal bands and anti-HTLV-1 antibodies may be present. The proviral load in the CSF correlate with disease activity and prognosis.
Histologiy of the speinal cord shows
(1) chronic inflammation of the gray and white matter with increased CD8 positive lymphocytes
(2) perivascular demyelination and axonal degeneration
Diagnosis involves:
(1) clinical findings
(2) demonstration of HTLV-1
(3) exclusion of other causes
