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MRI of AIDS-related polyradiculomyelitis
M L Whiteman1, B K Dandapani, R T Shebert
1Department of Radiology, University of Miami School of Medicine, FL 33136.
Objective:
We describe the unusual syndrome of cytomegalovirus (CMV) polyradiculomyelitis and its MR findings in two patients with AIDS.
Materials And Methods:
The clinical records and MRI studies of two patients with AIDS and CMV polyradiculomyelitis were reviewed. The MR images were performed on a Picker 1.0 or 1.5 T MR unit. Axial and sagittal T1-weighted images of the lumbar spine were obtained, pre- and post-Gd-DTPA (0.1 mmol/kg) administration. Gradient echo sagittal images were also obtained.
Results:
Precontrast images demonstrated a thickened cauda equina in both patients. In one patient the conus was ill defined on precontrast images. Post-contrast images demonstrated diffuse enhancement of the cauda equina in both patients as well as enhancement along the surface of the conus. In one patient the nerve roots were clumped and adherent to the walls of the thecal sac as well as to other nerve roots.
Conclusion:
The clinical presentation of urinary retention, flaccid paraparesis, back and/or leg pain, and "saddle anesthesia" in a patient with AIDS should suggest the diagnosis of CMV polyradiculomyelitis. Although diffuse enhancement of the cauda equina on postcontrast MRI is a nonspecific finding, it would strongly support this diagnosis in the appropriate clinical setting. The diagnosis may be easily missed without the use of a contrast agent.
Insights
Cytomegalovirus (CMV) polyradiculomyelitis in AIDS patients presents with specific MR findings. Contrast-enhanced MRI is crucial for diagnosing this condition, which can otherwise be missed.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Cytomegalovirus (CMV) can cause polyradiculomyelitis, a rare neurological syndrome.
- Acquired Immunodeficiency Syndrome (AIDS) is a significant risk factor for opportunistic infections like CMV.
Observation:
- Two patients with AIDS presented with symptoms suggestive of CMV polyradiculomyelitis.
- MRI revealed a thickened cauda equina and diffuse enhancement post-contrast.
Findings:
- Precontrast MRI showed a thickened cauda equina and ill-defined conus medullaris in one patient.
- Postcontrast MRI demonstrated diffuse cauda equina enhancement and nerve root clumping in one patient.
Implications:
- Clinical presentation of urinary retention, paraparesis, and pain in AIDS patients should raise suspicion for CMV polyradiculomyelitis.
- Postcontrast MRI findings, while nonspecific, strongly support the diagnosis in the correct clinical context.
- Contrast agents are essential for accurate MRI diagnosis of CMV polyradiculomyelitis.