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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.55 no.4 São Paulo  1997

http://dx.doi.org/10.1590/S0004-282X1997000500008 

Ressonância magnética na mielopatia associada ao HTLV-I: Leucoencefalopatia e atrofia medular

 

Magnetic resonance in HTLV-I associated myelopathy: leukoencephalopathy and spinal cord atrophy

 

 

Ana Claudia FerrazI; Alberto Alain GabbaiII; Nitamar AbdalaIII; Roberto Gomes NogueiraIV

IMestre em Neurologia, Disciplina de Neurologia, Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM)
IIProfessor Livre Docente, Disciplina de Neurologia, UNIFESP-EPM
IIIMestre em Radiologia, Departamento de Diagnóstico por Imagem, UNIFESP-EPM
IVProfessor Adjunto, Departamento de Diagnóstico por Imagem, UNIFESP-EPM

 

 


RESUMO

Lesões na substância branca cerebral e atrofia medular têm sido descritas em pacientes com mielopatia associada ao HTLV-I (MAH). A freqüência e a importância clínica destes achados ainda não são totalmente conhecidas. Vinte e nove pacientes foram estudados por ressonância magnética (RM) do crânio e da coluna. Imagens com hipersinal em T2 na substância branca, de diâmetro igual ou superior a 3 mm foram consideradas anormais. O tamanho da medula foi avaliado usando índice por nós denominado "índice medular". Os achados neurorradiológicos foram correlacionados às características clínicas da mielopatia. Lesões na substância branca cerebral ocorreram em 52% dos pacientes e atrofia medular ocorreu em 74%. Não houve correlação entre os achados neurorradiológicos e as características clínicas estudadas. Os resultados sugerem que a RM é um método útil na detecção de anormalidades cerebrais e medulares em pacientes com MAH. As lesões de substância branca não apresentaram correlação com idade ou com fatores de risco cardiovascular e podem estar associadas à infecção pelo vírus HTLV-I.

Palavras-chave: HTLV-I, paraparesia espástica tropical, imagem por ressonância magnética.


ABSTRACT

Cerebral white matter lesions and spinal cord atrophy have been frequently reported in patients with HTLV-I associated myelopathy (HAM). The exact frequency and the clinical relevance of these findings still remain to be elucidated. Twenty-nine patients with HAM were studied by magnetic resonance imaging of the brain and spine. Cerebral white matter lesions equal or over 3 mm in diameter were considered abnormal. The spinal cord size was evaluated using an index we have called "spinal cord index". The radiological findings were correlated to the clinical features of the myelopathy. Cerebral white matter lesions occurred in 52% of the patients, and spinal cord atrophy in 74%. There was no significant correlation between these abnormalities and the clinical features studied. These findings suggest that the resonance imaging is a useful method for detection of cerebral and spinal cord abnormalities in HAM patients. The absence of correlation between cerebral white matter lesions and either patient age or risk factors for cardiovascular disease suggests a possible association between the leukoencephalopathy and the infection.

Key words: HTLV-I, paraparesis, tropical spastic, magnetic resonance imaging.


 

 

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Aceite: 8-agosto-1997.

 

 

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