Abstract
The human T cell lymphotropic virus type 1 (HTLV-1) is a retrovirus that infects about 20 million individuals worldwide. Its typical neurological presentation is of a chronic, slowly progressive myelopathy named “HTLV-1-associated myelopathy/tropical spastic paraparesis” (HAM/TSP). HAM/TSP emerges as the tip of the iceberg among numerous other neurological clinical syndromes caused by this virus, such as inflammatory myopathies, polyneuropathies, ALS-like syndromes, dysautonomia, etc. HAM/TSP designates a spastic paraparesis with neurogenic bladder, and minor sensory signs. Pathologically, HAM/TSP is characterized initially by perivascular lymphocytic cuffing and mild parenchymal mononuclear infiltrates affecting mainly the thoracic spinal cord. This is followed by gliosis and scarring in later stages. The neuropathogenesis of HTLV-1 is still poorly understood but is apparently immune mediated. The therapy of TSP/HAM remains basically symptomatic.
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