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PT  - JOURNAL ARTICLE
AU  - Candy, S.
AU  - Chang, G.
AU  - Andronikou, S.
TI  - Acute Myelopathy or Cauda Equina Syndrome in HIV-Positive Adults in a Tuberculosis Endemic Setting: MRI, Clinical, and Pathologic Findings
AID  - 10.3174/ajnr.A3958
DP  - 2014 Aug 01
TA  - American Journal of Neuroradiology
PG  - 1634--1641
VI  - 35
IP  - 8
4099  - http://www.ajnr.org/content/35/8/1634.short
4100  - http://www.ajnr.org/content/35/8/1634.full
SO  - Am. J. Neuroradiol.2014 Aug 01; 35
AB  - 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 & 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. TBtuberculosisARVantiretroviralEBEpstein-Barr virus