Answer
Care for patients with HIV-associated vacuolar myelopathy (VM) is primarily supportive. Although no specific treatment is currently approved for this syndrome, viral control tailored to the individual patient's medical and viral history is important, as clinical and radiologic improvement with highly active retroviral therapy (HAART) have been described. [12, 13, 14, 5]
A pilot study showed improvement in patients treated with L-methionine. [15] However, a randomized, double-blind, placebo-controlled study of 56 patients showed no benefit. [16]
Symptomatic management relies on antispasmodics such as baclofen or tizanidine and intramuscular botulinum toxin to manage spasticity, pain management, and anticholinergic drugs to improve bladder function. [17]
Refer the patient to a physical medicine specialist for spinal cord treatment and follow-up care.
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Spinal cord from patient with vacuolar myelopathy that shows extensive spongiform changes in the white matter (Luxol fast blue stain) (contributed by Dr. Beth Levy, Saint Louis University School of Medicine, St. Louis, MO).
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Marked vacuolation is apparent in this Luxol fast blue stained photomicrograph (contributed by Dr. Beth Levy, Saint Louis University School of Medicine, St. Louis, MO).
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High-intensity lesion in the C2-C5 posterior spinal cord on T2-weighted sagittal MRI consistent with HIV myelopathy.
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High-intensity lesion in the posterior cervical cord on T2-weighted axial MRI consistent with HIV myelopathy.
