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<meta name="DC.Title" content="Acute Myelopathy or Cauda Equina Syndrome in HIV-Positive Adults in a Tuberculosis Endemic Setting: MRI, Clinical, and Pathologic Findings" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3958" />
<meta name="DC.Date" content="2014-08-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Cape Town is the center of an HIV-tuberculosis coepidemic. This study's aim was to highlight the importance and to describe the MR imaging features of tuberculosis in acute myelopathy and cauda equina syndrome in HIV-positive adults. To accomplish this we retrospectively reviewed the MR imaging and clinico-pathologic findings of HIV-positive patients presenting to our hospital with recent onset paraplegia and sphincter dysfunction over a 4-year period, 2008–2011.

MATERIALS &amp; METHODS: MR imaging, CD4 count, and CSF analysis and pathology were correlated in 216 cases.

RESULTS: Fifty-eight percent (127) of subjects were female. The mean age was 37 years. The median CD4 count was 185 cells/μL. Twenty-five percent (54) of patients were on antiretroviral therapy. MR imaging showed spondylitis in 30% (65). The median CD4 count in these patients was significantly higher than in the remainder. Disk destruction was common and 10% had synchronous spondylitis elsewhere in the spinal column. Thirty percent (64) had features of myelitis/arachnoiditis. Twenty-five percent (55) had no MR imaging abnormality. In 123 (57%) of cases with a definitive etiology on CSF culture or biopsy, 84 (68%) were attributable to tuberculosis including all spondylitis cases and 40% of nonspondylitis cases. Twelve (10%) were due to nontuberculous infection and 12 (10%) had HIV-associated tumors including 2 rare Epstein-Barr–related tumors.

CONCLUSIONS: In our setting, acute onset myelopathy/cauda equina syndrome in HIV-positive patients is largely attributable to tuberculosis with nonspondylitic forms being more common than spondylitis and associated with a lower CD4 count.

TB
:   tuberculosis
ARV
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EB
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<meta name="DC.Contributor" content="S. Candy" />
<meta name="DC.Contributor" content="G. Chang" />
<meta name="DC.Contributor" content="S. Andronikou" />
<meta name="article:published_time" content="2014-08-01" />
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<meta name="citation_title" content="Acute Myelopathy or Cauda Equina Syndrome in HIV-Positive Adults in a Tuberculosis Endemic Setting: MRI, Clinical, and Pathologic Findings" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Cape Town is the center of an HIV-tuberculosis coepidemic. This study9s aim was to highlight the importance and to describe the MR imaging features of tuberculosis in acute myelopathy and cauda equina syndrome in HIV-positive adults. To accomplish this we retrospectively reviewed the MR imaging and clinico-pathologic findings of HIV-positive patients presenting to our hospital with recent onset paraplegia and sphincter dysfunction over a 4-year period, 2008–2011.&lt;/p&gt;&lt;h3&gt;MATERIALS &amp;amp; METHODS:&lt;/h3&gt;
&lt;p&gt;MR imaging, CD4 count, and CSF analysis and pathology were correlated in 216 cases.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Fifty-eight percent (127) of subjects were female. The mean age was 37 years. The median CD4 count was 185 cells/μL. Twenty-five percent (54) of patients were on antiretroviral therapy. MR imaging showed spondylitis in 30% (65). The median CD4 count in these patients was significantly higher than in the remainder. Disk destruction was common and 10% had synchronous spondylitis elsewhere in the spinal column. Thirty percent (64) had features of myelitis/arachnoiditis. Twenty-five percent (55) had no MR imaging abnormality. In 123 (57%) of cases with a definitive etiology on CSF culture or biopsy, 84 (68%) were attributable to tuberculosis including all spondylitis cases and 40% of nonspondylitis cases. Twelve (10%) were due to nontuberculous infection and 12 (10%) had HIV-associated tumors including 2 rare Epstein-Barr–related tumors.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;In our setting, acute onset myelopathy/cauda equina syndrome in HIV-positive patients is largely attributable to tuberculosis with nonspondylitic forms being more common than spondylitis and associated with a lower CD4 count.&lt;/p&gt;" />
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<meta name="twitter:title" content="Acute Myelopathy or Cauda Equina Syndrome in HIV-Positive Adults in a Tuberculosis Endemic Setting: MRI, Clinical, and Pathologic Findings" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Cape Town is the center of an HIV-tuberculosis coepidemic. This study's aim was to highlight the importance and to describe the MR imaging features of tuberculosis in acute myelopathy and cauda equina syndrome in HIV-positive adults. To accomplish this we retrospectively reviewed the MR imaging and clinico-pathologic findings of HIV-positive patients presenting to our hospital with recent onset paraplegia and sphincter dysfunction over a 4-year period, 2008–2011.

MATERIALS &amp; METHODS: MR imaging, CD4 count, and CSF analysis and pathology were correlated in 216 cases.

RESULTS: Fifty-eight percent (127) of subjects were female. The mean age was 37 years. The median CD4 count was 185 cells/μL. Twenty-five percent (54) of patients were on antiretroviral therapy. MR imaging showed spondylitis in 30% (65). The median CD4 count in these patients was significantly higher than in the remainder. Disk destruction was common and 10% had synchronous spondylitis elsewhere in the spinal column. Thirty percent (64) had features of myelitis/arachnoiditis. Twenty-five percent (55) had no MR imaging abnormality. In 123 (57%) of cases with a definitive etiology on CSF culture or biopsy, 84 (68%) were attributable to tuberculosis including all spondylitis cases and 40% of nonspondylitis cases. Twelve (10%) were due to nontuberculous infection and 12 (10%) had HIV-associated tumors including 2 rare Epstein-Barr–related tumors.

CONCLUSIONS: In our setting, acute onset myelopathy/cauda equina syndrome in HIV-positive patients is largely attributable to tuberculosis with nonspondylitic forms being more common than spondylitis and associated with a lower CD4 count.

TB
:   tuberculosis
ARV
:   antiretroviral
EB
:   Epstein-Barr virus" />
<meta name="og-title" property="og:title" content="Acute Myelopathy or Cauda Equina Syndrome in HIV-Positive Adults in a Tuberculosis Endemic Setting: MRI, Clinical, and Pathologic Findings" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/35/8/1634" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Cape Town is the center of an HIV-tuberculosis coepidemic. This study's aim was to highlight the importance and to describe the MR imaging features of tuberculosis in acute myelopathy and cauda equina syndrome in HIV-positive adults. To accomplish this we retrospectively reviewed the MR imaging and clinico-pathologic findings of HIV-positive patients presenting to our hospital with recent onset paraplegia and sphincter dysfunction over a 4-year period, 2008–2011.

MATERIALS &amp; METHODS: MR imaging, CD4 count, and CSF analysis and pathology were correlated in 216 cases.

RESULTS: Fifty-eight percent (127) of subjects were female. The mean age was 37 years. The median CD4 count was 185 cells/μL. Twenty-five percent (54) of patients were on antiretroviral therapy. MR imaging showed spondylitis in 30% (65). The median CD4 count in these patients was significantly higher than in the remainder. Disk destruction was common and 10% had synchronous spondylitis elsewhere in the spinal column. Thirty percent (64) had features of myelitis/arachnoiditis. Twenty-five percent (55) had no MR imaging abnormality. In 123 (57%) of cases with a definitive etiology on CSF culture or biopsy, 84 (68%) were attributable to tuberculosis including all spondylitis cases and 40% of nonspondylitis cases. Twelve (10%) were due to nontuberculous infection and 12 (10%) had HIV-associated tumors including 2 rare Epstein-Barr–related tumors.

CONCLUSIONS: In our setting, acute onset myelopathy/cauda equina syndrome in HIV-positive patients is largely attributable to tuberculosis with nonspondylitic forms being more common than spondylitis and associated with a lower CD4 count.

TB
:   tuberculosis
ARV
:   antiretroviral
EB
:   Epstein-Barr virus" />
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<div id="hw-article-author-popups-top-node-13597--61323177082" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S. Candy </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (S.C., G.C.), Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BCandy%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Candy%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BCandy%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">G. Chang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (S.C., G.C.), Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BChang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chang%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AG.%2BChang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">S. Andronikou </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (S.A.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BAndronikou%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Andronikou%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BAndronikou%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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<div class="cit ref-cit ref-journal" id="cit-35.8.1634.30"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Chong</span>  <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Di Rocco</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Tagliati</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">MR findings in AIDS-associated myelopathy</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">1999</span>;<span class="cit-vol">20</span>:<span class="cit-fpage">1412</span>–<span class="cit-lpage">16</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIyMC84LzE0MTIiO3M6NDoiYXRvbSI7czoyMDoiL2FqbnIvMzUvOC8xNjM0LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">31.</span><a class="rev-xref-ref" href="#xref-ref-31-1" title="View reference 31. in text" id="ref-31">↵</a>

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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 35</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 8 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Aug 2014 </div></div>
      
      
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      <div class="highwire-cite-title">Acute Myelopathy or Cauda Equina Syndrome in HIV-Positive Adults in a Tuberculosis Endemic Setting: MRI, Clinical, and Pathologic Findings</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Candy</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Chang</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Andronikou</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2014, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">35 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1634-1641; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3958 </span></div>
  
  
  
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