Diagnostic challenges in vacuolar myelopathy: a didactic case report

Area of Science:

• Neurology
• Infectious Diseases
• Neuroimaging

Background:

• HIV-vacuolar myelopathy (HIVM) is complex to diagnose, often identified postmortem.
• Neuro-AIDS is increasingly significant in the era of HAART.
• This report details diagnostic challenges in HIVM using spinal MRI.

Purpose of the Study:

• To highlight diagnostic difficulties in HIV-vacuolar myelopathy.
• To present a case study with MRI findings and 1-year follow-up.
• To emphasize the importance of viral load assessment in HIVM diagnosis.

Main Methods:

• Case report of a 49-year-old male with progressive weakness and neurological symptoms.
• Utilized MRI fiber-tracking of the spine.
• Assessed HIV load in cerebrospinal fluid (CSF).

Main Results:

• Patient presented with spastic paraparesis, sensory deficits, and herpes zoster.
• MRI ruled out thoracic myelon lesions and CNS opportunistic infections.
• Markedly elevated HIV load in CSF confirmed HIV-associated vacuolar myelopathy.

Conclusions:

• A negative or non-specific MRI does not exclude HIV-related myelopathy.
• Assessing both peripheral and central viral loads is crucial.
• This approach helps identify potential CSF HIV-escape.