HTLV-1 associated myelopathy (HAM) with severe orthostatic hypotension - A case report

M. Takao, T. Yamawaki, N. Suzuki

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1 Citation (Scopus)

Abstract

We present a case of HAM with severe orthostatic hypotension. A 62-year-old woman was admitted to Mito Red Cross Hospital because of orthostatic dizziness and severe gait disturbance. Physical examination revealed a severe orthostatic hypotension (142/90 mmHg (supine) vs. 84/70 mmHg (standing)). Neurological examination revealed weakness and hyperreflexia in the lower extremities, as well as extensor plantar response and spastic gait. In tests of autonomic nervous system, there was no reflex bradycardia in Aschner eye ball pressure test and carotidal sinus reflex, no overshoot in Valsalva test, and electrocardiogram revealed a low value in CVR-R. The imprint techniques under 1% pilocarpine subcutaneous administration revealed a marked disturbance of sudomotor function. Blood cell counts, blood chemistry and urinalysis were unremarkable. The serological examination revealed a high titer value of anti-HTLV-1 antibody. Anti HTLV-1 antibody and oligoclonal IgG band were detected in the cerebrospinal fluid. Magnetic resonance imaging (MRI) of the cerebrum demonstrated multiple small high intensity areas in the white matter, but these lesions showed no gadolinium enhancement. Since the test of the autonomic nervous system revealed both sympathetic and parasympathetic disturbance, it is important to investigate the autonomic disturbance including orthostatic hypotension in cases of HAM.

Original languageEnglish
Pages (from-to)842-844
Number of pages3
JournalClinical Neurology
Volume34
Issue number8
Publication statusPublished - 1994 Jan 1

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Keywords

  • HTLV-1
  • HTLV-1 associated myelopathy
  • autonomic nervous disease
  • orthostatic hypotension

ASJC Scopus subject areas

  • Clinical Neurology

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