Ernst Florian, Klausner Fritz, Kleindienst Waltraud, Bartsch Heinrich, Taylor Ninon, Trinka Eugen
Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCITReCS), Salzburg, Austria.
Division of Neuroradiology, Paracelsus Medical University Salzburg , Salzburg, Austria.
Spinal Cord Ser Cases. 2016 Sep 15;2:16020. doi: 10.1038/scsandc.2016.20. eCollection 2016.
Because of the diagnostic complexity and potential pitfalls in interpreting test results, HIV-vacuolar myelopathy (HIVM) is far more often diagnosed postmortem than . In the era of highly active antiretroviral therapy (HAART), the topic of neuro-AIDS has become increasingly important. This case report covers some of the diagnostic problems encountered in vacuolar myelopathy based on magnetic resonance imaging (MRI) fiber-tracking pictures of the spine in a patient with HIVM, including a 1-year follow-up.
A 49-year-old man felt progressive weakness, and difficulties while walking, and he suffered from incomplete voiding. A week before admission, follicles appeared on the right side of his neck and shoulder. His medical history included a chronic HIV infection treated with HAART and a B-cell lymphoma in complete remission after chemotherapy. The initial exam revealed thoracic hyposensitivity level distal to dermatome Th9, spastic paraparesis of the lower limbs and herpes zoster infection in dermatome C3/C4. A lesion of the thoracic myelon could be ruled out in the MRI scan, chemotherapy-induced polyneuropathy was stable, and no acute opportunistic infection of the CNS was found. HIV load in cerebrospinal fluid (CSF) was markedly elevated. An HIV-associated vacuolar myelopathy was diagnosed, revealing the HIV itself as etiology.
A negative or unspecific MRI scan excludes possible other causes, but by no means rules out HIV-related myelopathy. Furthermore, peripheral and central viral load should always be assessed to avoid missing a possible 'CSF HIV-escape'.
由于诊断的复杂性以及解读检测结果时可能存在的陷阱，与尸检后诊断相比，HIV 空泡性脊髓病（HIVM）生前确诊的情况要少得多。在高效抗逆转录病毒治疗（HAART）时代，神经艾滋病这一话题变得越发重要。本病例报告涵盖了一名 HIVM 患者基于脊柱磁共振成像（MRI）纤维追踪图像在空泡性脊髓病诊断中遇到的一些问题，包括为期 1 年的随访情况。
一名 49 岁男性感到进行性肌无力、行走困难，且存在排尿不完全的问题。入院前一周，其颈部右侧和肩部出现皮疹。他的病史包括接受 HAART 治疗的慢性 HIV 感染以及化疗后完全缓解的 B 细胞淋巴瘤。初始检查显示胸 9 皮节以下胸部感觉减退、下肢痉挛性轻瘫以及颈 3/颈 4 皮节带状疱疹感染。MRI 扫描排除了胸髓病变，化疗所致多发性神经病病情稳定，未发现中枢神经系统急性机会性感染。脑脊液（CSF）中的 HIV 载量显著升高。诊断为 HIV 相关空泡性脊髓病，确定病因是 HIV 本身。
MRI 扫描结果为阴性或不具有特异性可排除其他可能病因，但绝不能排除 HIV 相关脊髓病。此外，应始终评估外周和中枢病毒载量，以避免漏诊可能的“脑脊液 HIV 逃逸”情况。
