S Candy1, G Chang1, S Andronikou2. 1. From the Department of Radiology (S.C., G.C.), Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. 2. Department of Radiology (S.A.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
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.
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-positivepatients 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-positivepatients is largely attributable to tuberculosis with nonspondylitic forms being more common than spondylitis and associated with a lower CD4 count.
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