Answer
Answer
Vacuolar myelopathy (VM) typically presents as a posterolateral spinal cord syndrome often limited to the thoracic cord. It manifests as a slowly progressive, painless spastic paraperesis with sensory loss, imbalance, and sphincter dysfunction. Relapsing-remitting courses have been described. [3]
Back pain is not prominent. Arm function is usually normal except for advanced cases.
VM is often associated with AIDS dementia complex and peripheral neuropathy. In such cases, patients have cognitive decline and distal limb pain and numbness.
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Media Gallery
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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.
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