Disclosures: Lane M. Lagattuta, DO: No financial relationships or conflicts of interest

Case Description: The patient is a 50-year-old female with history of TIA/stroke without any residual deficits who presents with lower extremity weakness and spasticity following a motor vehicle accident.

Setting: Academic, quaternary care university hospital

Patient: 50-year-old female presenting with functional decline and increased spasticity. Assessment/

Results: The patient underwent extensive workup including infectious serological tests, MRI/MRA brain, MRI of the spine, EMG, and EEG. EMG revealed chronic right lumbosacral radiculopathy but no evidence of right upper extremity neuropathy or right cervical radiculopathy and no diffuse polyneuropathy. Notable results include MRI brain with hyperintensity in the subcortical and deep white matter. Subsequent laboratory testing revealed positive HTLV-1 antibodies.

Discussion: HTLV-1 associated myelopathy affects less than 2% of HTLV-1 carriers and is more common in females than males. Diagnosis involves serologic or CSF analysis for HTLV-1 antibodies and lobulated lymphocytes. CSF will have increased protein and mild lymphocytic pleocytosis. MRI may be normal or have atrophy of the cervical or thoracic cord and/or white matter lesions in the subcortical and periventricular regions. Management is largely symptom driven, with some studies showing corticosteroids being used to slow progression and reduce neurologic disability. Preliminary trials with monoclonal antibody treatment resulted in improvement in spasticity and reduced motor disability.

Conclusion: HTLV-1 associated myelopathy is characterized by slow onset of progressive weakness and spasticity in the lower extremities, hyperreflexia, ankle clonus and lumbar pain, all commonly seen in physiatric settings. After ruling out more common diagnoses, physiatrists should consider HTLV-1 antibody testing as treatment is straightforward and can significantly prolong disease progression limiting disability.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/progressive-lower-extremity-weakness-and-spasticity-due-to-htlv-1-associated-myelopathy-tropical-spastic-paraparesis-ham-tsp-a-case-report/