tropical spastic paraparesis
Introduction
Introduction to tropical sputum Tropical spastic paraparesis (TSP) is a neurological endemic disease prevalent in many tropical and subtropical countries. It is a spinal cord inflammation caused by chronic infection of human T-lymphocytic virus type 1 (HTLV-1). The HTLV-1 associated myelopathy (HAM) found in southern Japan is also the disease. Concealed onset, slow progress, clinical manifestations of spastic paraplegia. Anti-HTLV-1 antibody is positive in blood and cerebrospinal fluid, and glucocorticoid therapy has a certain effect. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of transmission: blood transmission, sexual transmission Complications: ataxia
Cause
Tropical spastic paraplegia
(1) Causes of the disease
HTLV-1 virus is a neurotropic retrovirus. In 1985, Gessain et al found anti-HTLV-1 IgG antibody in the serum of TSP patients in Martinique, with a positive rate of 68%. Later in Jamaica, Colombia. The same antibody was found in the serum of Japanese patients, which laid the foundation for the etiology of tropical spastic paraplegia. Currently, the virus can be isolated from cultured peripheral blood cells and cerebrospinal fluid mononuclear cells, but not from brain tissue. Separated in the middle.
(two) pathogenesis
The disease is transmitted through sexual contact, using contaminated syringes, breast-feeding and infusion of blood products. The lesions mainly involve the corticospinal tract and the posterior cord of the spinal cord, which are symmetrical and severe degeneration. Some cases may involve the cortical cerebellar tract. And cortical thalamic tract, Clarke column and anterior horn have neuronal loss, spinal cord root, optic nerve, auditory nerve demyelination changes, in some acute cases there is inflammatory cell infiltration.
Prevention
Tropical spastic paraplegia prevention
The disease is mainly transmitted by infusion of blood products, sexual contact, use of contaminated syringes and breastfeeding. Once the nervous system damage occurs, treatment is more difficult, so prevention is more important.
Complication
Tropical spastic paraplegia complications Complications, ataxia
Ataxia, optic nerve damage, trauma, infection.
Symptom
Symptoms of tropical spastic paraplegia common symptoms, weakness, reflex, sphincter dysfunction, cerebellar ataxia, sensory disturbance, ataxia paraplegia
The onset of the disease is concealed, mainly manifested as weakness of the lower limbs, stiffness, and gradually worsened. The neurological examination revealed hyperreflexia in both lower extremities, Babinski sign positive, and some patients had early sphincter dysfunction, which may have different degrees of sensory disturbance, but usually Only involving the lower limbs, manifested as paresthesia, positional sensation, hypotonia, and a small number of patients may be associated with multiple peripheral neuropathy, cerebellar ataxia, optic nerve damage, motor neuron damage and polymyositis under both lower extremities, The upper limbs (except for active tendon reflexes), the brain and brainstem are generally not affected.
Examine
Tropical spastic paraplegia
1. The number of cerebrospinal fluid cells is slightly increased, which is (10-50)×109/L, mainly lymphocytes, protein can be normal, or mildly elevated, more than 80% of patients are positive for anti-HTLV-1 antibody, cerebrospinal fluid IgG index Elevated, an oligoclonal band directed against HTLV-1 appeared.
2. T lymphocyte leukemia-like cells can be detected in peripheral blood, serum anti-HTLV-1 antibody is positive, and some patients have positive serum syphilis test.
3. MRI examination shows that the brain is normal and the spinal cord may have atrophy.
Diagnosis
Diagnosis and identification of tropical spastic paraplegia
Adults with chronic spinal cord lesions with lesions of lower limb pyramidal tracts, especially in endemic areas, should be alert to this disease, cerebrospinal fluid anti-HTLV-1 antibody positive, oligoclonal bands specific for HTLV-1, It is helpful for diagnosing this disease.
The diseases to be identified include spinal cord compression, chronic progressive multiple sclerosis, primary lateral sclerosis, and hereditary spastic paraplegia.
1. Spinal cord MRI is easy to distinguish between spinal cord MRI.
2. Chronic progressive multiple sclerosis (CPMS) Tropical spastic paraplegia and spinal cord CPMS are sometimes difficult to identify, but the following are rarely seen in multiple sclerosis, 1 peripheral nerve and muscle involvement, 2 serum In the oligoclonal band, multi-leaf lymphocytes (mature T-lymphocytic leukemia-like cells) appeared in 3 blood or cerebrospinal fluid, and 4 serum syphilis antibodies were positive.
3. Primary lateral sclerosis is generally not affected by the sensory, immunological examination is negative.
4. Hereditary spastic paraplegia usually has an earlier onset age and is more negative in immunological examination.
