Relapsing cervical cord lesions on MRI in patients with HTLV-I–associated myelopathy

Human T lymphotropic virus type I (HTLV-I) is associated with adult T cell leukemia (ATL) and a chronic progressive disease of the CNS termed HTLV-I–associated myelopathy (HAM)/tropical spastic paraparesis (TSP).1,2 The most common MRI findings of HAM/TSP are spinal cord atrophy predominantly involving the thoracic cord levels. In this article, we report two patients with HAM/TSP, who developed transient cervical cord lesions on MRI during the course of the illness. Patient 1 is 39-year-old woman who developed progressive gait and urinary disturbance when she was 22 years old. At age 35, she was diagnosed with HAM/TSP. MRI taken at age 37 showed spinal cord atrophy predominantly in the thoracic region (see figure E-1 on the Neurology Web site at www.neurology.org). Despite various treatments, her symptoms gradually worsened. At age 39, she noticed numbness and pain in the right upper limbs. On neurologic examination, muscle strength in the lower limbs was moderately decreased. Deep tendon reflexes were mildly exaggerated in the upper limbs and highly exaggerated in …