Araújo A de Q, Alfonso C R, Schor D, Leite A C, de Andrada-Serpa M J
HTLV-associated Neuropathies Unit, Evandro Chagas Hospital, Fiocruz, Brazil.
Acta Neurol Scand. 1993 Jul;88(1):59-62. doi: 10.1111/j.1600-0404.1993.tb04188.x.
In Rio de Janeiro (RJ) most cases of paraparesis of obscure origin are associated with the human T-cell lymphotropic virus type I (HTLV-I). Thirty-four consecutive patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) from RJ were evaluated. Most patients came from low socio-economic levels. There was no difference in terms of gender. The main affected racial group was white. A history of sexually transmitted diseases was a major risk factor for HAM/TSP and a positive serology for syphilis was found in 26.5% of the patients. The major clinical findings were of a spastic paraparesis with generalized brisk tendon jerks and bilateral Babinki's sign. Sensation was abnormal in 25 patients (73.5%) and five (14.7%) had a sensory level. Three patients (8.8%) had optic atrophy. The cerebrospinal fluid showed a lymphocytic pleocytosis with a mean total protein content of 0.4 g/litre, and an increased intrathecal IgG synthesis in 59.4% of patients. HAM/TSP and multiple sclerosis (MS) occur indigenously in RJ and some HAM/TSP cases can be sometimes confused with MS. Therefore we propose that, in places where MS coexist with HAM/TSP, HTLV-I antibodies should be sought routinely in those MS suspected cases with prominent spastic paraparesis.
在里约热内卢（RJ），大多数病因不明的截瘫病例与I型人类T细胞嗜淋巴细胞病毒（HTLV-I）有关。对来自RJ的34例连续的HTLV-I相关脊髓病/热带痉挛性截瘫（HAM/TSP）患者进行了评估。大多数患者来自社会经济水平较低的阶层。在性别方面没有差异。主要受影响的种族群体是白人。性传播疾病史是HAM/TSP的主要危险因素，26.5%的患者梅毒血清学呈阳性。主要临床发现为痉挛性截瘫，伴有全身性腱反射亢进和双侧巴宾斯基征。25例患者（73.5%）感觉异常，5例（14.7%）有感觉平面。3例患者（8.8%）有视神经萎缩。脑脊液显示淋巴细胞增多，平均总蛋白含量为0.4克/升，59.4%的患者鞘内IgG合成增加。HAM/TSP和多发性硬化症（MS）在RJ本土发生，一些HAM/TSP病例有时可能与MS混淆。因此，我们建议，在MS与HAM/TSP共存的地区，对于那些有明显痉挛性截瘫的疑似MS病例，应常规检测HTLV-I抗体。
