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

Ferraz, Ana Claudia; Gabbai, Alberto Alain; Abdala, Nitamar; Nogueira, Roberto Gomes

doi:10.1590/S0004-282X1997000500008

Resumos

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.

HTLV-I; paraparesia espástica tropical; imagem por ressonância magnética

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.

HTLV-I; paraparesis; tropical spastic; magnetic resonance imaging

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 Ferraz^I; Alberto Alain Gabbai^II; Nitamar Abdala^III; Roberto Gomes Nogueira^IV

^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.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 8-agosto-1997.

Dra. Ana Claudia Ferraz - Rua Pascal 1937 - 04616-005 São Paulo SP - Brasil. FAX: 011 543 4768.

1. Alcindor F, Valderrama R, Canavaggio VM, et al.. Imaging of human T-Iymphotropic virus type I associated chronic progressive myeloneuropathies. Neuroradiology 1992;35:69-74.
2. Andrade ASF, Brites C, Santos SRS, et al.. HTLV-I/II as a common etiology of myelopathies in Bahia, Brazil. Braz J Med Biol Res 1996;29:757-761.
3. Araújo AQC, Afonso CR, Schor D, Leite AC, Andrada-Serpa MJ. Clinical and demographic features of HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Rio de Janeiro, Brazil. Acta Neurol Scand 1993;88:59-62.
4. Berger JR, Tornatore C, Major EO, et al.. Relapsing and remitting human immunodefeciency virus associated leukoencephalomyelopathy. Ann Neurol 1992;31:34-38.
5. Braffman BH, Zimmerman RA, Trojanowski JA, et al.. Pathologic correlation with gross and histopathology: 2. Hyperintense white matter foci in the elderly. Am J Roentgenol 1988;151:559-566.
6. Carpenter MG. Neuroanatomia humana. Rio de Janeiro: Interamericana, 1978 p:199. (Medula: anatomia macroscópica e estrutura interna).
7. Cruickshank JR, Rudge P, Dalgleish AG, et al.. Tropical spastic paraparesis and human T cell lymphotropic virus type 1 in the United Kingdon. Brain 1989;112:1057-1090.
8. Farmer JA, Gott AM, Phil D. Risk factors for coronary artery disease. In Braunwald E. Heart disease. Ed4. Philadelphia: W.B. Saunders. 1992:1125-1155.
9. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimme man RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. Am J Neruroradiol 1987;8:421-426.
10. Francis GS, Evans AC, Arnold DL. Neuroimaging in multiple sclerosis. Neurol Clin 1995;13: 147-171.
11. Gabbai AA, Bordin JO, Vieira JPB, et al.. Selectivity of human T lymphotropic virus type 1 (HTLV-1) and type 2 infection among different populations in Brasil. Am J Trop Med Hyg 1993;49:178-185.
12. George AE, Leon MJ, Kalnin A, Rosner L, Goodgold A, Chase N. Leukoencephalopathy in normal and pathologic againg: 2. MRI of brain lucencies. Am J Neuroradiol 1986;7:567-570.
13. George AE, Leon MJ. Computed tomography, magnetic resonence imaging, and positron emission tomography in aging and dementing disorders. In Latchaw, R.E. (ed.) MR and CT imaging of the head, neck, and spine. St. Louis: Mosby- Year Book, 1991:413-442.
14. Gerard G, Weisberg LA. MRI periventricular lesions in adults. Neurology 1986;36:998-1001.
15. Godoy AJ, Kira J, Hasuo K, Goto I. Characterization of cerebral white matter lesions of HTLV-I-associated myelopathy/ tropical spastic paraparesis in comparison with multiple sclerosis and collagen-vasculitis: a semiquantitative MRI study. J Neurol Sci 1995;133:102-111.
16. Hara Y, Takahashi M, Ueno S, Yoshikawa H, Yorifuji S, Taruiu S. MR imaging of the brain in myelopathy associated with human T-cell lymphotropic virus type I. J Comput Assist Tomogr 1988;12:750-754.
17. Kermode AG, Rudge P, Thompson AJ, Boulay, EPGH, McDonald WI. MRI of thoracic cord in tropical spastic paraparesis. J Neurol Neurosurg Psychiatry 1990;52:1110-1111.
18. Kira J, Minato S, Itoyama Y, Goto I, Kato M, Hasuo K. Leukoencephalopathy in HTLV-I associated myelopathy: MRI and EEG data. J Neurol Sci 1988;87:221-232.
19. Kirkpatrick JB, Hayman LA. White matter lesions in MR imaging of clinically healthy brains of elderly subjects: possible pathologic basis. Radiology 1987;162:509-511.
20. Kuroda Y, Fujiyama F, Nagumo F. Analysis of factors of relevance to rapid clinical progression in HTLV-I-associated myelopathy. J Neurol Sci 1991; 105:61-66.
21. Kuroda Y, Matsui M, Yukitake M, et al.. Assessment of MRI criteria for MS in Japanese MS and HAM/TSP. Neurology 1995;45:30-33.
22. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983;33:1444-1452.
23. Lasserve ET, Gout O, Gessain A, et al.. HTLV-I brain abnormalities on magnetic resonance imaging and relation with multiple sclerosis. Lancet 1987;2:49-50.
24. Miller DH, Ormerod IEC, Gibson A, Boulay EPGH, Rudge P, McDonald WI. MR brain scanning in patients with vasculitis: differentiation from multiple sclerosis. Neuroradiology 1987;29:226-231.
25. Muniz MR, Caramelli P, Domingues RB, Marchiori PE, Bacheschi LA, Scaff M. Cranial and spinal MRI findings in HTLV-I associated myelopathy/ tropical spastic paraparesis. Neurology 1996;46(Suppl 2):A239-240.
26. Nakagawa M, Izumo S, Ijichi S, et al.. HTLV-I associated myelopathy: analysis of 213 patients based on clinical features and laboratory findings. J Neurovirol 1995;1:50-61.
27. Newton M, Miller D, Rudge P, et al.. Antibody to human T-lymphotropic virus type 1 in West-Indian- born UK residentes with spastic paraparesis. Lancet 1987;1:415-418.
28. Offenbacher H, Fazekas F, Schmidt R et al. Assessment of MRI criteria for a diagnosis of MS. Neurology 1993;43:905-909.
29. Ogata A, Nagashima K, Tashiro K, Miyakawa A, Mikuni C. MRI pathological correlated of brain lesion in a necropsy case of HTLV-I associated myelopathy. J Neurol Neurosurg Psychiatry 1993;56:194-196.
30. Osame M, Matsumoto M, Usuku R, et al.. Chronic progressive myelopathy associated with elevated antibodies to human T-cell leukemia-like cells. Ann Neurol 1987;21:117-122.
31. Poser C, Paty D, Scheinberg L, et al.. New diagnostic criteria for multiple sclerosis. Ann Neurol 1983;13:227-231.
32. Rao KCVG. The CSF spaces. In: Lee SH, Rao KCVG, Zimmerman RA. Cranial MRI and CT. Ed3. New York: McGraw-Hill 1992:227-294.
33. Roman GC, Schoenberg BS, Madden DL, et al.. Human T-lymphotropic vims type I antibodies in the serum of patients with tropical spastic paraparesis in the Seychelles. Arch Neurol 1987;44:605-607.
34. Rudge P, Ali A, Cruickshank JK. Multiple sclerosis, tropical spastic paraparesis and HTLV-1 infection in Afro-Caribbean patients in the United Kingdon. J Neurol Neurosurg Psychiatry 1991;54:689-694.
35. Sheremata WA, Berger JR, Harrington WH, Ayyar D.R, Staford M, De Freitas E. Human T lymphotropic virus type I-associated myelopathy. Arch Neurol 1992;49:1113-1118.
36. Vernant JC, Maurs L, Gessain A, et al.. Endemic tropical spastic paraparesis associated with human T-lymphotropic virus type I: a clinical and seroepidemiological study of 25 cases. Ann Neurol 1987;21:123-130.
37. World Health Organization. Report of the scientific group on HTLV-I and associated diseases, Kagoshima, Japan, December, 1988. Virus Diseases. Human T-lymphotropic virus type I, HTLV-I. Wkly Epidemiol Rec 1989;64:382-383.

Datas de Publicação

Publicação nesta coleção
07 Out 2010
Data do Fascículo
1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Alcindor F, Valderrama R, Canavaggio VM, et al.. Imaging of human T-Iymphotropic virus type I associated chronic progressive myeloneuropathies. Neuroradiology 1992;35:69-74.

[2] 2. Andrade ASF, Brites C, Santos SRS, et al.. HTLV-I/II as a common etiology of myelopathies in Bahia, Brazil. Braz J Med Biol Res 1996;29:757-761.

[3] 3. Araújo AQC, Afonso CR, Schor D, Leite AC, Andrada-Serpa MJ. Clinical and demographic features of HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Rio de Janeiro, Brazil. Acta Neurol Scand 1993;88:59-62.

[4] 4. Berger JR, Tornatore C, Major EO, et al.. Relapsing and remitting human immunodefeciency virus associated leukoencephalomyelopathy. Ann Neurol 1992;31:34-38.

[5] 5. Braffman BH, Zimmerman RA, Trojanowski JA, et al.. Pathologic correlation with gross and histopathology: 2. Hyperintense white matter foci in the elderly. Am J Roentgenol 1988;151:559-566.

[6] 6. Carpenter MG. Neuroanatomia humana. Rio de Janeiro: Interamericana, 1978 p:199. (Medula: anatomia macroscópica e estrutura interna).

[7] 7. Cruickshank JR, Rudge P, Dalgleish AG, et al.. Tropical spastic paraparesis and human T cell lymphotropic virus type 1 in the United Kingdon. Brain 1989;112:1057-1090.

[8] 8. Farmer JA, Gott AM, Phil D. Risk factors for coronary artery disease. In Braunwald E. Heart disease. Ed4. Philadelphia: W.B. Saunders. 1992:1125-1155.

[9] 9. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimme man RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. Am J Neruroradiol 1987;8:421-426.

[10] 10. Francis GS, Evans AC, Arnold DL. Neuroimaging in multiple sclerosis. Neurol Clin 1995;13: 147-171.

[11] 11. Gabbai AA, Bordin JO, Vieira JPB, et al.. Selectivity of human T lymphotropic virus type 1 (HTLV-1) and type 2 infection among different populations in Brasil. Am J Trop Med Hyg 1993;49:178-185.

[12] 12. George AE, Leon MJ, Kalnin A, Rosner L, Goodgold A, Chase N. Leukoencephalopathy in normal and pathologic againg: 2. MRI of brain lucencies. Am J Neuroradiol 1986;7:567-570.

[13] 13. George AE, Leon MJ. Computed tomography, magnetic resonence imaging, and positron emission tomography in aging and dementing disorders. In Latchaw, R.E. (ed.) MR and CT imaging of the head, neck, and spine. St. Louis: Mosby- Year Book, 1991:413-442.

[14] 14. Gerard G, Weisberg LA. MRI periventricular lesions in adults. Neurology 1986;36:998-1001.

[15] 15. Godoy AJ, Kira J, Hasuo K, Goto I. Characterization of cerebral white matter lesions of HTLV-I-associated myelopathy/ tropical spastic paraparesis in comparison with multiple sclerosis and collagen-vasculitis: a semiquantitative MRI study. J Neurol Sci 1995;133:102-111.

[16] 16. Hara Y, Takahashi M, Ueno S, Yoshikawa H, Yorifuji S, Taruiu S. MR imaging of the brain in myelopathy associated with human T-cell lymphotropic virus type I. J Comput Assist Tomogr 1988;12:750-754.

[17] 17. Kermode AG, Rudge P, Thompson AJ, Boulay, EPGH, McDonald WI. MRI of thoracic cord in tropical spastic paraparesis. J Neurol Neurosurg Psychiatry 1990;52:1110-1111.

[18] 18. Kira J, Minato S, Itoyama Y, Goto I, Kato M, Hasuo K. Leukoencephalopathy in HTLV-I associated myelopathy: MRI and EEG data. J Neurol Sci 1988;87:221-232.

[19] 19. Kirkpatrick JB, Hayman LA. White matter lesions in MR imaging of clinically healthy brains of elderly subjects: possible pathologic basis. Radiology 1987;162:509-511.

[20] 20. Kuroda Y, Fujiyama F, Nagumo F. Analysis of factors of relevance to rapid clinical progression in HTLV-I-associated myelopathy. J Neurol Sci 1991; 105:61-66.

[21] 21. Kuroda Y, Matsui M, Yukitake M, et al.. Assessment of MRI criteria for MS in Japanese MS and HAM/TSP. Neurology 1995;45:30-33.

[22] 22. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983;33:1444-1452.

[23] 23. Lasserve ET, Gout O, Gessain A, et al.. HTLV-I brain abnormalities on magnetic resonance imaging and relation with multiple sclerosis. Lancet 1987;2:49-50.

[24] 24. Miller DH, Ormerod IEC, Gibson A, Boulay EPGH, Rudge P, McDonald WI. MR brain scanning in patients with vasculitis: differentiation from multiple sclerosis. Neuroradiology 1987;29:226-231.

[25] 25. Muniz MR, Caramelli P, Domingues RB, Marchiori PE, Bacheschi LA, Scaff M. Cranial and spinal MRI findings in HTLV-I associated myelopathy/ tropical spastic paraparesis. Neurology 1996;46(Suppl 2):A239-240.

[26] 26. Nakagawa M, Izumo S, Ijichi S, et al.. HTLV-I associated myelopathy: analysis of 213 patients based on clinical features and laboratory findings. J Neurovirol 1995;1:50-61.

[27] 27. Newton M, Miller D, Rudge P, et al.. Antibody to human T-lymphotropic virus type 1 in West-Indian- born UK residentes with spastic paraparesis. Lancet 1987;1:415-418.

[28] 28. Offenbacher H, Fazekas F, Schmidt R et al. Assessment of MRI criteria for a diagnosis of MS. Neurology 1993;43:905-909.

[29] 29. Ogata A, Nagashima K, Tashiro K, Miyakawa A, Mikuni C. MRI pathological correlated of brain lesion in a necropsy case of HTLV-I associated myelopathy. J Neurol Neurosurg Psychiatry 1993;56:194-196.

[30] 30. Osame M, Matsumoto M, Usuku R, et al.. Chronic progressive myelopathy associated with elevated antibodies to human T-cell leukemia-like cells. Ann Neurol 1987;21:117-122.

[31] 31. Poser C, Paty D, Scheinberg L, et al.. New diagnostic criteria for multiple sclerosis. Ann Neurol 1983;13:227-231.

[32] 32. Rao KCVG. The CSF spaces. In: Lee SH, Rao KCVG, Zimmerman RA. Cranial MRI and CT. Ed3. New York: McGraw-Hill 1992:227-294.

[33] 33. Roman GC, Schoenberg BS, Madden DL, et al.. Human T-lymphotropic vims type I antibodies in the serum of patients with tropical spastic paraparesis in the Seychelles. Arch Neurol 1987;44:605-607.

[34] 34. Rudge P, Ali A, Cruickshank JK. Multiple sclerosis, tropical spastic paraparesis and HTLV-1 infection in Afro-Caribbean patients in the United Kingdon. J Neurol Neurosurg Psychiatry 1991;54:689-694.

[35] 35. Sheremata WA, Berger JR, Harrington WH, Ayyar D.R, Staford M, De Freitas E. Human T lymphotropic virus type I-associated myelopathy. Arch Neurol 1992;49:1113-1118.

[36] 36. Vernant JC, Maurs L, Gessain A, et al.. Endemic tropical spastic paraparesis associated with human T-lymphotropic virus type I: a clinical and seroepidemiological study of 25 cases. Ann Neurol 1987;21:123-130.

[37] 37. World Health Organization. Report of the scientific group on HTLV-I and associated diseases, Kagoshima, Japan, December, 1988. Virus Diseases. Human T-lymphotropic virus type I, HTLV-I. Wkly Epidemiol Rec 1989;64:382-383.