1naresh
Array ( [urn:ac.highwire.org:guest:identity] => Array ( [runtime-id] => urn:ac.highwire.org:guest:identity [type] => guest [service-id] => ajnr-ac.highwire.org [access-type] => Controlled [privilege] => Array ( [urn:ac.highwire.org:guest:privilege] => Array ( [runtime-id] => urn:ac.highwire.org:guest:privilege [type] => privilege-set [privilege-set] => GUEST ) ) [credentials] => Array ( [method] => guest ) ) ) 1nareshArray ( [urn:ac.highwire.org:guest:identity] => Array ( [runtime-id] => urn:ac.highwire.org:guest:identity [type] => guest [service-id] => ajnr-ac.highwire.org [access-type] => FreeToRead [privilege] => Array ( [urn:ac.highwire.org:guest:privilege] => Array ( [runtime-id] => urn:ac.highwire.org:guest:privilege [type] => privilege-set [privilege-set] => GUEST ) ) [credentials] => Array ( [method] => guest ) ) ) 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