Positive Babinski Reflex Research Articles

Improving stroke care in Indonesia: Integrating CT perfusion for enhanced prognostication and treatment guidance - A case report

Background. Over the last three decades, stroke management has witnessed substantial progress, from the introduction of recombinant tissue plasminogen activator (rtPA) in 1995 to the approval of thrombectomy in 2016. Intravenous tissue plasminogen activator (tPA) within 4.5 hours of symptom onset is the standard for eligible acute ischemic stroke patients, dissolving clots and restoring blood flow. Endovascular thrombectomy (EVT) surpasses intravenous thrombolysis for large vessel occlusion cases, typically within 6 to 24 hours based on CT-perfusion criteria. CT perfusion (CTP) provides crucial quantitative data on cerebral blood flow, aiding in ischemia detection, tissue assessment, treatment guidance, and outcome prediction. This case report marks a pivotal moment in Indonesian stroke management, introducing the inaugural use of CTP for diagnostic purposes. By scrutinizing blood flow dynamics and cerebral conditions, CTP augments conventional diagnostics, offering enhanced prognostic value. Case presentation. The case of a 58-year-old male with notable comorbidities exemplifies this successful integration. He presented with sudden left-sided weakness and dysarthria, without accompanying symptoms. Neurological evaluation revealed a Glasgow Coma Scale score of E3M6V5, 7th cranial nerve paresis, and a positive Babinski reflex on the left side. With a National Institute of Health Stroke Scale (NIHSS) score of 10, a head CT scan rules out cerebral hemorrhage, prompting precise thrombolysis at 0.7 mg/kg. Within one hour post-thrombolysis, the NIHSS score improved to 6, ultimately culminating in an NIHSS score of 2 upon discharge. Conclusion. This case underscores the efficacy of acute ischemic stroke management, fortified by the strategic integration of CTP, heralding a new era in Indonesian stroke care.

Clinical and Metagenomic Characterization of Neurological Infections of People With Human Immunodeficiency Virus in the Peruvian Amazon.

Neurological opportunistic infections cause significant morbidity and mortality in people with human immunodeficiency virus (HIV) but are difficult to diagnose. One hundred forty people with HIV with acute neurological symptoms from Iquitos, Peru, were evaluated for cerebral toxoplasmosis with quantitative polymerase chain reaction (qPCR) of cerebrospinal fluid (CSF) and for cryptococcal meningitis with cryptococcal antigen test (CrAg) in serum or CSF. Differences between groups were assessed with standard statistical methods. A subset of samples was evaluated by metagenomic next-generation sequencing (mNGS) of CSF to compare standard diagnostics and identify additional diagnoses. Twenty-seven participants were diagnosed with cerebral toxoplasmosis by qPCR and 13 with cryptococcal meningitis by CrAg. Compared to participants without cerebral toxoplasmosis, abnormal Glasgow Coma Scale score (P = .05), unilateral focal motor signs (P = .01), positive Babinski reflex (P = .01), and multiple lesions on head computed tomography (CT) (P = .002) were associated with cerebral toxoplasmosis. Photophobia (P = .03) and absence of lesions on head CT (P = .02) were associated with cryptococcal meningitis. mNGS of 42 samples identified 8 cases of cerebral toxoplasmosis, 7 cases of cryptococcal meningitis, 5 possible cases of tuberculous meningitis, and incidental detections of hepatitis B virus (n = 1) and pegivirus (n = 1). mNGS had a positive percentage agreement of 71% and a negative percentage agreement of 91% with qPCR for T gondii. mNGS had a sensitivity of 78% and specificity of 100% for Cryptococcus diagnosis. An infection was diagnosed by any method in only 34% of participants, demonstrating the challenges of diagnosing neurological opportunistic infections in this population and highlighting the need for broader, more sensitive diagnostic tests for central nervous system infections.

Diagnosing Functional Neurological Disorder through History and Physical Examination: A Case Report

Differentiating between stroke and stroke mimics (i.e., non-vascular conditions) is a major challenge, as they often involve similar presenting symptoms. A common type of stroke mimic is functional neurological disorder (FND), a somatic disorder caused by severe stress, emotional conflict, or a psychiatric disorder usually presenting with one or more neurologic symptoms. This condition is associated with voluntary motor and sensory symptoms that are internally inconsistent with identifiable neurological diseases and lack structural lesions. We describe a 54-year-old female with a history of transient ischemic attack resulting in bilateral blindness and recent social stressors, who presented with right-sided facial and extremity motor and sensory deficits, bilateral diplopia, and dysphagia. Her left upper and lower extremities had 2 out of 5 motor strength, a weak hand squeeze, and a positive Babinski reflex on the contralateral side of her weakness, which resolved the next day. In addition, decreased sensation to light touch and temperature over the right arm and leg were appreciated without a dermatomal pattern. Given the negative stroke work-up, atypical physical exam findings, prior history of blindness, and in the setting of recent psychological stressors, her acute motor and sensory deficits were diagnosed as FND after evaluation by the Neurology service. The current case demonstrates the following important features of making a FND diagnosis: 1) careful history taking in eliciting potential psychological stressors; 2) a comprehensive neurological examination assessing the presence of findings specific for FND (e.g., greater weakness with active rather than passive movements, fluctuating weakness); 3) multidisciplinary collaboration with neurology and psychiatry providers to aid in performing a comprehensive assessment.

Diagnosis and Treatment of Tuberculous Meningoencephalitis and Toxoplasma Encephalitis in Positive HIV Patient: Case Report

Background Tuberculous meningoencephalitis (TBME) and toxoplasma encephalitis (TE) are the most frequent cerebral opportunistic infections in positive HIV patients in developed countries. This study aims to determine a presumptive diagnosis of TBME and TE based only on clinical, CD4-count, and radiology features and to attend suitable early treatment for better patient outcomes. Case Description A 40-year-old presented to the emergency unit of dr. Mintohardjo Naval Hospital with decreased consciousness. History of positive HIV status, pulmonary tuberculosis for six months and anti-tubercular-treatment (ATT) drop-out. The GCS was E2M5V2, lung crackles, nuchal rigidity, positive Babinski reflex, and duplex hemiparesis. CD4-count: 4 cells/mm3. Multiple hypodense lesions, “finger-like-oedema”, featured on non-contrast head CT-scan. A lumbar puncture was not performed. Treatment of TBME included an ATT regimen, pyridoxine, cotrimoxazole, anti-oedema, and TE treatment included clindamycin and pyrimethamine. Based on the clinical and radiological diagnosis of TBME (nuchal rigidity, history of ATT drop-out, multiple hypodense lesions on CT-scan) and TE (altered mental status, duplex hemiparesis, CD4-count, “finger-like-oedema” projections on CT-scan), ATT and TE treatment were given for ten days. There were significant clinical improvements by GCS E4M6V3, negative nuchal rigidity after being treated early by ATT and TE treatment. Conclusions Presumptive Diagnosis of TBME and TE in HIV patients can be determined only based on clinical, CD4-count, and radiology examination. However, there are significant clinical improvements in giving ATT along with TE treatment immediately in positive HIV patients.

P015 Imaging findings in cervical spine in patients with Juvenile Idiopathic Arthritis in Tunisia

Abstract Background Juvenile Idiopathic Arthritis (JIA) is a chronic disease characterized by prolonged synovial inflammation that may cause structural joint damage. However, little is known about cervical spine involvement in JIA. The main objective of this study is to describe radiological findings of the cervical spine in patients with JIA. Methods We conduct a retrospective monocentric study. All JIA patients were included (ILAR criteria). Sociodemographic, JIA subtype, and clinical characteristics were collected. Disease activity at JIA diagnosis was evaluated by JADAS10 (Juvenile Arthritis Disease Activity Score) in poly and oligoarticular subtypes and by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) in arthritis-related enthesitis form. Cervical spine radiographs including anteroposterior and lateral with flexion views were analyzed. A p-value < 0.05 was considered significant. Results We included 25 patients (16 girls and 9 boys) diagnosed with JIA with a mean age at disease onset of 9.9 ± 3.9 [3–16]. The median disease duration was 36 months (IQR 25–75%; 30–84). The JIA subtypes were in decreasing order of frequency: Enthesitis-related Arthritis (n = 9), Oligoarticular (n = 6), Polyarticular RF- (n = 4), Polyarticular RF + (n = 2), Systemic (n = 2), Psoriatic Arthritis (n = 1), and Undifferentiated (n = 1). Median ESR and CRP were 17 mm/h [2–98] and 15.4 mg/l [0–56] respectively. The Median BASDAI score was 2.8 [1–6.3]. Median JADAS10 score was 5.3 [0–20]. Four patients (16%) were on long-term corticosteroid therapy. Five patients (20 %) have a cervical spine involvement with the following subtypes: Polyarticular (n = 2), enthesitisenthesitis-related arthritis (n = 2), and systemic (n = 1). Clinical manifestations were neck pain (n = 3) and limited range of motion (n = 4). Neurological examination noted brisk deep tendon reflexes (n = 6), positive Babinski reflex (n = 1) and positive Hoffmann reflex (n = 2). No patient had a neurological deficit. The conventional radiographs of the cervical spine showed: loss of cervical lordosis (n = 2), diastasis C1-C2 (n = 3), erosion of the odontoid process (n = 1), and anterior ankylosis (n = 3). Subsequent cervical spine MRI confirmed these findings and showed pannus at the craniocervical junction in one case and block vertebra of C6-C7 in another case. Atlanto-axial subluxation was anteroposterior in 3 patients and rotatory in one. Conclusion Cervical spine involvement is frequent and underestimated in JIA, and its radiological features are various. Hence, regular radiographic monitoring of the cervical spine is required to prevent the development of this complication.

Meningeal Melanocytoma of the Middle Cranial Fossa: A Case Report

Summary The term meningeal melanocytoma was first introduced by Limas and Tio in 1972 to figure out lesions of the central nervous system that, under light microscope view, have meningioma characteristics, and ultrastructural characteristics of melanocyte neoplasm, respectively. Meningeal melanocytomas (MM) represent 0.06-0.1% of brain tumors. The annual incidence is about 1 per 10 million. This type of neoplasm is rarely seen in clinical practice. A few cases have been reported in the literature. A 62-year-old man was admitted, complaining of trigeminal pain in the area of the I and II branches of CN V on the left of his face. He underwent two surgeries in a row. First, malignant melanoma, and then meningeal melanocytoma were histologically verified. Neurological examination demonstrated hyperpigmented left iris, neuralgic pain in I and II branches of CN V, latent central hemiparesis and hemihypesthesia for the right extremities, positive Babinski reflex on the right, positive axial pathological reflexes, and partial motor aphasia. Primary intracranial meningeal melanocytoma is difficult to diagnose preoperatively because of the tumor’s non-specific clinical and neuroradiological characteristics. So electron microscopy and immunohistochemical additional diagnostic confirmation are mandatory. Immunohistochemical findings - the presence of S-100 protein, vimentin, and antimelanocyte antigen HMB-45, no reaction for EMA and ultrastructural (melanosomes in different maturation, contacts type zonula adherens) are all in favour of the histopathological diagnosis of MM. Meningeal melanocytoma is a slow-growing tumor, biologically benign, and attempts for surgical radicalism are recommended. It is not entirely clear whether a malignant transformation of these tumors is possible. The role of chemotherapy also remains questionable and has not been documented as effective.

Cocaine as a rare cause of locked-in syndrome: a case report

IntroductionIn the United States, cocaine is a commonly used drug of abuse. It is also a recognized contributing factor for both hemorrhagic and ischemic strokes. However, cocaine-induced basilar artery thrombosis has rarely been reported in the literature.Case presentationOur patient was a 51-year-old African American woman with a history of polysubstance abuse who presented to the emergency department for acute behavior changes. Later, during admission, she had a dramatic decrease in motor strength in all extremities and a positive Babinski reflex bilaterally. The results of her toxicology reports were positive for cocaine; in addition, results of magnetic resonance angiography and magnetic resonance imaging were consistent with acute thrombosis and subsequent infarction of the basilar artery. Her mental status improved, but she was only able to communicate via movements of her eyes.ConclusionOur patient developed locked-in syndrome after use of cocaine. Given the prevalence of its use in the United States, cocaine use should be included among the potential causes of locked-in syndrome.

Bilateral lower limb paralysis as initial symptom of neurofibromatosis type 2: A case report

Neurofibromatosis type 2 (NF2) is an autosomal dominant disorder characterized by multiple tumors including schwannomas, meningiomas and ependymomas of the central nervous system. Although paresthesias, muscle weakness, muscle atrophy, and gait unsteadiness have been reported as clinical symptoms of spinal tumors, there are no reports of patients with NF2 who developed paralysis. A 7-year-old female consulted with our hospital because of sudden bilateral lower limb paralysis. She had not recognized the abnormalities, including paralysis, paraplegia and muscle weakness of bilateral lower limb before administration. Because of the aggravated bilateral patellar tendon reflexes, Achilles tendon reflexes, and the positive bilateral Babinski reflexes, a magnetic resonance imaging (MRI) of the spinal cord was performed. MRI revealed multiple spinal tumors in the cervical, thoracic, lumbar, and sacral regions. In particular, a 12 mm × 33 mm spinal tumor was present in the thoracic region and was pressing against the spinal cord. Surgery was urgently performed to remove the spinal tumor in the thoracic region. Histopathological examination revealed that the tumor was a schwannoma. Gadolinium-enhanced MRI of the head was performed to explore the intra-cranial lesions: bilateral vestibular schwannomas and tumors in the left oculomotor nerve and right glossopharyngeal nerve were also discovered. Auditory brainstem response was performed to evaluate the bilateral VSs, and the results were normal. Nine months after the surgery, MRI of the head and spinal cord showed that her tumors had not increased in size. This represents the first reported case of NF2 complicated bilateral lower limb paralysis as initial neurological symptom.

Cervical myelopathy caused by anomalies at the craniovertebral junction

A 46-year-old woman was admitted to our department with dizziness for 1 month. Neurologic examination revealed hypesthesia on the left side, hyperreflexia in the right extremities and positive Babinski reflexes bilaterally. Magnetic resonance image and computed tomography scan were performed and demonstrated hyperplasia of the squamous occipital bone and the posterior arch of the atlas and hypoplasia of the posterior arch of C1 (Figure). A dorsal midline approach was performed to decompress the cervicomedullary junction.

Gliomatosis Cerebri in a 12-Year-Old Patient

A previously healthy 12-year-old boy was admitted with a subacute right facial droop, deteriorating handwriting, and frequent falls. Examination revealed mild hemiparesis, lower motor neuron facial palsy, and a positive Babinski reflex on the right side. He also exhibited ataxia and bilateral dysmetria. During the next few months, he progressively developed quadriparesis, bilateral internuclear ophthalmoplegia, multiple cranial nerve palsies, a pseudobulbar affect, and a hyperreflexic neurogenic bladder.

Mediastinal Mass Causing Spinal Cord Compression

A 4-year-old Cambodian male presented to the emergency room with 2 weeks of gradually increasing leg weakness until he could no longer stand. He was also reported to have a deformity on his back, intermittent fevers and cough. His physical exam was notable for a 2 cm × 1 cm bony protrusion at his T4 vertebrae, and 2/5 strength and positive Babinski reflexes in his lower extremities. A chest x-ray showed a 3.2 cm × 2.9 cm mass in the middle mediastinum extending to the posterior mediastinum. A purified protein derivative test was positive. A computed tomography scan showed findings consistent with pulmonary tuberculosis and a paravertebral mass with amorphous calcifications, which involved destruction of the T4-T5 vertebrae and evidence of cord compression. These findings were all consistent with tuberculous spondylitis (Pott's disease).

A positive Babinski reflex predicts delayed neuropsychiatric sequelae in Chinese patients with carbon monoxide poisoning.

As the human population increased in China, the carbon monoxide is a serious environmental toxin in public health. However, predicting the delayed neuropsychiatric sequelae (DNS) of carbon monoxide poisoning (COP) has not been well studied. We investigated the independent predictors of DNS in patients with COP. This study was conducted at four hospitals in China. Data were retrospectively collected from 258 patients with COP between November 1990 and October 2011. DNS was the primary endpoint. A positive Babinski reflex was the independent predictor for DNS: sensitivity = 53.8% (95% confidence interval [CI]: 26.1–79.6), specificity = 88.6% (95% CI: 83.7–92.1), positive predictive value (PPV) = 20.0% (95% CI: 9.1–37.5), and negative predictive value (NPV) = 97.3% (95% CI: 94.0–98.9). The area under the receiver operating characteristic curve = 0.712 (95% CI: 0.544–0.880). A positive Babinski reflex was very memorable, immediately available, and applicable in clinical practice. Even when the sensitivity and PPV of a positive Babinski reflex were unsatisfactory, it had a good specificity and NPV for excluding the risk of DNS. In patients without a positive Babinski reflex, the risk for DNS was only 2.7%. This finding may help physicians make decisions about dispositions for patients with COP.

Clinical and imaging characterization of progressive spastic dysarthria

To describe speech, neurological and imaging characteristics of a series of patients presenting with progressive spastic dysarthria as the first and predominant sign of a presumed neurodegenerative disease. Participants were 25 patients with spastic dysarthria as the only or predominant speech disorder. Clinical features, pattern of MRI volume loss on voxel-based morphometry and pattern of hypometabolism on F18-fluorodeoxyglucose positron emission tomography (FDG-PET) scan are described. All patients demonstrated speech characteristics consistent with spastic dysarthria, including strained voice quality, slow speaking rate, monopitch and monoloudness, and slow and regular speech alternating motion rates. Eight patients did not have additional neurological findings on examination. Pseudobulbar affect, upper motor neuron pattern limb weakness, spasticity, Hoffman sign and positive Babinski reflexes were noted in some of the remaining patients. Twenty-three patients had electromyographic assessment and none had diffuse motor neuron disease or met El Escorial criteria for amyotrophic lateral sclerosis. Voxel-based morphometry revealed striking bilateral white matter volume loss affecting the motor cortex (BA 4), including the frontoparietal operculum (BA 43) with extension into the middle cerebral peduncle. FDG-PET showed subtle hypometabolism affecting the premotor and motor cortices in some patients, particularly in those who had a disease duration longer than 2years. A neurodegenerative disorder that begins focally with spastic dysarthria due to involvement of the motor and premotor cortex and descending corticospinal and corticobulbar pathways is characterized. The descriptive label 'progressive spastic dysarthria' to best capture the dominant presenting feature of the syndrome is proposed.

A CASE OF RELAPSING-REMITTING TUMEFACTIVE MULTIPLE SCLEROSIS

A 23-year-old left-handed female developed progressive right arm weakness and expressive dysphasia. She had papilloedema and right-sided UMN facial palsy, arm weakness and positive Babinski reflex. MRI brain demonstrated a...

No relapse of neuromyelitis optica during drug-induced B-lymphopenia with hypogammaglobulinemia

Anticonvulsants have been effective for tonic seizures of neuromyelitis optica (NMO) and multiple sclerosis (MS). Some anticonvulsants are immunosuppressants. It has been reported that carbamazepine (CBZ) administration lowers γ-globulin levels, presumably in connection with B cells.1 Neuromyelitis optica has specific anti-aquaporin-4 antibody (AQP4Ab) positivity; this is supported by the connection to antibody-mediated immunity. We report a case of a patient with NMO whose relapse of NMO was suppressed during secondary B lymphopenia. ### Case report. A 29-year-old woman gave birth to a boy in May 2003. In mid-July, she had weakness in her right upper limb, and weakness in all 4 extremities lasting 2 weeks. She was admitted to our hospital in August. Neurologic evaluation showed weakness of the neck and 4 extremities, exaggerated deep tendon reflexes in all 4 extremities, positive bilateral Babinski reflexes, and bilateral loss of sensation below the C2 level. She had dysuria and constipation. Expanded Disability Status Scale (EDSS) was 5.5. …

An 8-year-old boy with gait disturbance and the rapid increase of muscle tonus

The patient is an 8-year-old boy with gait disturbance and rapid increase of muscle tonus. He was born uneventfully at 40 weeks gestation and weighed 3120 g. He was able to walk alone at the age of 18 months, but speech was delayed until 24 months. At 3 years, his speech became unclear and he began to fall frequently. At 6 years, he entered to an ordinary class at elementary school, and was able to run, walk down stairs using a handrail, as well as read, write and calculate normally. Walking disturbance with pes equinovarus and clumsy hands began at 7 years of age. By 8 years he was unable to walk and was referred to our hospital. Neurological examination revealed a dystonic posture, athetotic movements, hyper-reflexia in the lower extremities and positive Babinski reflex. His speech was slurred and an articulation disturbance was noted. In addition, his swallowing was interrupted. His clinical course worsened, with his dystonia, athetosis and opistotonic posture becoming aggravated at 3 months after admission to the hospital. He expired at the age of 8 years and 10 months because of choking on sputum. Laboratory examination on admission revealed that complete blood count and blood chemistry were within normal ranges, including 52.3 mg/dL Fe, 108.2 mg/dL Cu, 38.2 mg/dL ceruloplasmin, 6.4 m/dL lactate and 0.27 mg/dL pyruvate. CSF showed no cell count, 12.7 mg/dL total protein and 59 m/dL sugar. Serum amino acid analysis, WBC and a lysosomal enzyme assay of eight enzymes were within normal ranges. Nerve conduction velocity and needle electromyograph were normal. Electroencephalography showed a dysrythmic awake pattern and no paroxysmal discharges. His intelligence quotient was 67 by the Tanaka Binet test. Fundoscopy showed a retinal pigment degeneration. CT scan revealed no abnormalities in the cerebral cortex and white matter, but symmetrical speckled high densities in the bilateral basal ganglia (Fig. 1). No MRI findings were available.

Babinski reflex and the CUT reflex - a comparative study

The Babinski reflex and the CUT reflex were examined in 150 neurological patients and 20 controls. A positive CUT reflex occurred more frequently than a positive Babinski reflex in the patient material as a whole, and in different diagnostic groups. However, there was a low grade of correspondence between a positive CUT reflex and a positive Babinski reflex. There were many positive CUT reflexes in the group of normal persons. In a number of cases the examination of the CUT reflex was impossible because of lack of strength or incooperability. The study indicates that the CUT reflex and the Babinski reflex are not comparable phenomena.

Endoskopische Projektilextraktion zur Behandlung einer Kopfschußverletzung

A 14-year-old boy had in war-torn Bosnia sustained a transcranial gunshot wound from a 7.65 mm bullet. After primary medical care with craniotomy and the removal of bony fragments and cerebral debris followed by a duraplasty, he was transported to the French-German Field Hospital. On arrival he was breathing spontaneously and in stable cardiovascular state but with impaired responsiveness and somnolent. His pupils were moderately dilated with slight anisocoria (right > left). His gaze was deviated to the left and he had vertical gaze paralysis as well as right central facial nerve paresis. In addition he had a mild diencephalic syndrome, right hemiplegia and a right hemihypaesthesia with increased muscle tone, especially of the leg, paratonia and right positive Babinski reflex. There also was a marked ciliospinal reflex and he had a bulbar speech as well as cognitive and memory abnormalities. Haemoglobin and haematocrit were below normal (12.1 g/dl and 35.0%, respectively), while biochemical tests were normal. Cranial computed tomography localized the bullet in the pineal recess of the 3rd ventricle and the lamina quadrigemina. These findings indicated endoscopic transcranial removal of the bullet, achieved with a rigid endoscope and forceps along the entry track. Subsequent intensive care proceeded without complication. On discharge the boy was normal oriented and ready to make contact. The neurological defects were regressing. Endoscopic transcranial removal of a bullet wedged in the brain is a relatively sparing neurological procedure which, under unusual circumstances and conditions, can achieve a satisfactory result even with limited facilities.

Advanced lung cancer presenting with a generalized seizure in pregnancy

This case describes the initial presentation of lung cancer as a generalized seizure in a woman at 31 weeks gestation. Histologic examination revealed evidence of placental metastases without evide...

Human T-cell lymphotropic virus type I (HTLV-I) confirmed by PCR-Southern blot and sequencing analysis in a woman with tropical spastic paraparesis

Human T-cell lymphotropic virus type I (HTLV-I) is a human retrovirus and the aetiological agent of a progressive neurological disease called tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM), as confirmed by evidence accumulated in HTLV-I seroprevalence studies. TSP/HAM is rarely diagnosed in Italy, given the low prevalence of HTLV-I in the population. TSP/HAM begins insidiously in the fourth decade, mainly with spastic paraparesis of the lower extremities and positive Babinski reflex, as well as interfering with bowel and bladder functions. In this study we report the clinical, virological and haemato chemical data of a 54-year-old woman, born in the Ivory Cost, with symptoms suggestive of TSP. The presence of HTLV-I infection was demonstrated by the detection of antibodies in serum and in cerebrospinal fluid by immunoenzymatic assay and Western blot analysis. In addition, viral isolation was carried out in peripheral blood cells, and the presence of HTLV-I proviral DNA was confirmed by polymerase chain reaction/Southern blot and sequencing analysis. According to our results, HTLV-I testing might be useful when TSP/HAM is suspected.