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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(07): s00451809935
DOI: 10.1055/s-0045-1809935
Original Article

Magnetic resonance imaging in the diagnosis of HTLV-1-associated myelopathy

João Marcos Carvalho 
1   Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Imunologia, Salvador BA, Brazil.
2   Universidade Federal da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador BA, Brazil.
,
Sheila Nunes Ferraz 
1   Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Imunologia, Salvador BA, Brazil.
2   Universidade Federal da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador BA, Brazil.
,
José Abraão Neto 
1   Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Imunologia, Salvador BA, Brazil.
2   Universidade Federal da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador BA, Brazil.
,
Saul Schnitman 
3   Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Neurologia, Salvador BA, Brazil.
,
Augusto M. Carvalho 
1   Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Imunologia, Salvador BA, Brazil.
2   Universidade Federal da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador BA, Brazil.
4   Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT), Salvador BA, Brazil.
5   Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador BA, Brazil.
,
Edgar M. Carvalho 
1   Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Imunologia, Salvador BA, Brazil.
2   Universidade Federal da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador BA, Brazil.
4   Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT), Salvador BA, Brazil.
5   Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador BA, Brazil.
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Funding This work was supported by the Função de Amparo à Pesquisa do Estado da Bahia (FAPESB), grant number INC0003/2019.
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Abstract

Background

The main neurologic manifestation of definitive human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy (HAM) is spastic paraparesis, but it only occurs in 5% of the patients. In contrast, about 40% of HTLV-1-infected subjects present symptoms of urologic dysfunction, including nocturia, urgency, and incontinence, which may progress to an inability to void urine. As these patients do not present motor dysfunction, they are classified as probable HAM. Atrophy of the thoracic spinal cord (SC) is the main abnormality found on magnetic resonance image (MRI) scans of patients with definitive HAM, but damage to the SC has not been reported in patients with probable HAM.

Objective

To determine if, through an evaluation of the metrics of conventional MRI, we can detect a decrease in the area of the SC in patients with probable HAM.

Methods

Infection by HTLV-1 was herein diagnosed by a Western blot, and the MRI scan was performed using a 1.5-T scanner. Atrophy was considered when the SC area was less than 25% of the intrathecal area.

Results

We observed a progressive reduction in all segments of the SC area among HTLV-1 carriers, patients with probable and definitive HAM. Significantly, 48.3% of patients with probable HAM presented atrophy of the lumbar area.

Conclusion

Using MRI metrics, the present study shows the atrophy of lumbar segments of the SC area in patients who present urinary symptoms associated with HTLV-1 but without motor dysfunction.

Keywords

Human T-lymphotropic Virus 1 - Paraparesis, Tropical Spastic - Magnetic Resonance Imaging - Lower Urinary Tract Symptoms

Authors' Contributions

Conceptualization: JMC, EMC; Data curation: JMC, SNF; Formal analysis: JMC, SNF, AMC, EMC; Methodology: JA, EMC; Project administration: EMC; Software: SNF; Supervision: EMC; Writing – original draft: JMC, AMC, EMC; Writing – review & editing: SNF, JA, SS, AMC, EMC.


Data Availability Statement

Datasets related to this article can be found at: https://drive.google.com/drive/folders/10s-8PezTrCfaf0ZThZwfRPLa2tiqBmBd?usp=sharing.


Editor-in-Chief: Hélio A. G. Teive (https://orcid.org/0000-0003-2305-1073).


Associate Editor: Leandro Tavares Lucato (https://orcid.org/0000-0001-9181-5245).




Publikationsverlauf

Eingereicht: 31. Januar 2025

Angenommen: 05. Mai 2025

Artikel online veröffentlicht:
22. Juli 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
João Marcos Carvalho, Sheila Nunes Ferraz, José Abraão Neto, Saul Schnitman, Augusto M. Carvalho, Edgar M. Carvalho. Magnetic resonance imaging in the diagnosis of HTLV-1-associated myelopathy. Arq Neuropsiquiatr 2025; 83: s00451809935.
DOI: 10.1055/s-0045-1809935
 

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