HIV vacuolar myelopathy
HIV vacuolar myelopathy is the most common chronic myelopathy associated with HIV infection, and is typically seen in the late stages of HIV infection.
Patients tend to have slowly progressive weakness of the lower extremities, gait disorders, sensory abnormalities in the lower limb, impotence, urinary frequency and urgency 4.
HIV infected mononuclear cells secrete neurotoxic factors. Another contributing factor may be the impaired ability to use vitamin B-12 as a source of methionine in transmethylation metabolism for myelin in the spinal cord (which may explain why findings are similar to those in subacute combined degeneration).
- spinal cord atrophy is the most common finding, typically involving the thoracic cord; cervical cord may also be involved
- bilateral symmetric dorsal column involvement can be seen: similar to subacute combined degeneration 1-3