neurologic disorders
HTLV 1–Associated Myelopathy Tropical Spastic Paraparesis (HAM TSP)
Diagnosis of HAM TSP
Serologic and polymerase chain reaction (PCR) tests of serum and CSF MRI HTLV-1–associated myelopathy/tropical spastic paraparesis is suggested by typical neurologic deficits that are otherwise unexplained, particularly in patients with risk factors. Serum and CSF serologic tests, PCR tests, and spinal cord MRI are indicated. If CSF-to-serum ratio of HTLV-1 antibodies is>1 or if PCR detects HTLV-1 antigen in CSF, the diagnosis is very likely. Protein and Ig levels in CSF may also be elevated, often with oligoclonal bands; lymphocytic pleocytosis occurs in up to 50% of patients. MRI shows spinal cord atrophy and T2-weighted images of the lateral columns and anterior nerve roots, which often appear hyperintense on MRI. 