Neurology: Case of the Month

Test Yourself — Patient 58

HTLV-1 Associated Myelopathy

1. All of the following are typical clinical features of HTLV-1 associated myelopathy (HAM/TSP) EXCEPT:
   • [ A ] Symptoms become evident during the 1st and 2nd decades of life.
   • [ B ] HAM/TSP is usually a slowly progressive spastic paraparesis.
   • [ C ] Over ninety percent of patients have spasticity with increased tendon reflexes.
   • [ D ] Over ninety percent of patients have urinary bladder dysfunction.
   • [ E ] Over sixty percent of patients have sensory disturbances.
2. Classic clinical diagnostic criteria for HAM/TSP include all of the following EXCEPT:
   • [ A ] Absence of difficulty with walking during school age.
   • [ B ] Symmetric weakness in the legs within six months of onset of disease.
   • [ C ] A course dominated by relapses and remissions of symptoms.
   • [ D ] Increased patellar reflexes.
3. The most effective means of HTLV-1 transmission is by:
   • [ A ] Mosquito-borne transmission.
   • [ B ] Transfusion of cellular components of blood.
   • [ C ] Transfusion of plasma.
   • [ D ] Sexual contact with infected partners.
   • [ E ] None of the above.
4. All of the following statements about HTLV-1 are true EXCEPT:
   • [ A ] Adult T-cell leukemia (ATLL) develops in 2-3% of HTLV-1 seropositive patients.
   • [ B ] HAM/TSP develops in less than 2% of HTLV-1 seropositive patients.
   • [ C ] Less than 2% of HTLV-1 seropositive patients develop systemic inflammatory conditions including uveitis, polymyositis, arthropathy and Sjogren's syndrome.
   • [ D ] Five percent of HTLV-1 infected patients are life-long asymptomatic carriers.
   • [ E ] Over 90% of HTLV-1 infected patients are life-long asymptomatic carriers.
5. Which of the following statements are TRUE?
   • [ A ] MRI findings of periventricular white matter changes can reliably distinguish between multiple sclerosis and HTLV-1 associated myelopathy.
   • [ B ] Oligoclonal bands are infrequently seen in the CSF of patients with HAM/TSP.
   • [ C ] Seropositivity to HTLV-1 is invariably specific for a clinical diagnosis of HAM/TSP.
   • [ D ] All of the above.
   • [ E ] None of the above.

 

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