[Tropical spastic paraparesis - anesthetic approach]

Area of Science:

• Anesthesiology
• Neurology

Background:

• Human T-lymphotropic virus type 1 (HTLV-1) infection is prevalent globally, causing neurological conditions like Tropical Spastic Paraparesis (TSP).
• TSP is a chronic spinal cord degeneration leading to motor deficits, sensory changes, and bladder dysfunction.

Observation:

• A 53-year-old female with HTLV-1 and TSP presented for cystectomy, exhibiting lower limb weakness, hyperreflexia, and neurogenic bladder symptoms.
• Due to coagulopathy and neurological concerns, an epidural catheter was contraindicated.
• General anesthesia was administered using etomidate, cisatracurium, midazolam, fentanyl, and desflurane.

Findings:

• The anesthetic management was uneventful, with no intraoperative or postoperative complications.
• The patient experienced no neurological deterioration during the perioperative period or hospitalization.
• The chosen anesthetic agents, etomidate and cisatracurium, were selected to avoid risks associated with propofol and rocuronium in this patient population.

Implications:

• This case demonstrates the feasibility of general anesthesia in patients with HTLV-1 and TSP.
• Careful selection of anesthetic agents is crucial to prevent potential neurological complications in patients with TSP.
• Further research may explore optimal anesthetic strategies for patients with HTLV-1-associated neurological disorders.