Acta Neurol Scand., 1986:73:590-598 zy Key words: zyxwvu AIDS; cytomegalovirus; myelopathy; polyradiculopathy; Marchiafava Bignami Spinal cord syndromes in the acquired immune deficiency syndrome B.M. Singh’, S. Levine’, R.L. Yarrish3,M.J. Hyland’, D. Jeanty4, G.P. Wormser3. Departments of lNeurology, ‘Pathology, Division of 31nfectious Diseases, New York Medical College, Valhalla and 4Westchester County Department of Laboratory and Research, New York, USA. zy ABSTRACT - Two patients with AIDS developed paraparesis. Neuropathological post mor- tern examination in one revealed cytomegaloviruspolyradiculopathy, and in the second, va- cuolar myelopathy which occurred in association with brain lesions resembling Marchiafava- Rignami Syndrome. zyxwvutsrq Accepred for publication December 19, 1985 Central nervous system complications occur in ap- proximately 30% of patients with acquired immune deficiency syndrome (AIDS) ( 1). Dementing ence- phalitis and . toxoplasma brain abscesses are the most commonly identified conditions. A vacuolar myelopathy pathologically resembling subacute combined degeneration has also been reported, but its etiology remains undetermined (2). We have re- cently identified 2 AIDS patients with a spinal cord syndrome. The first patient had polyradiculopathy due to cytomegalovirus (CMV) and the second pa- tient had a myelopathy similar to subacute com- bined degeneration but with associated lesions re- sembling Marchiafava-Bignami syndrome. This re- port describes the clinical and pathological features of these patients. Material and methods Patient zyxwvutsrq 1. A 37-year-old hispanic prisoner was admitted to Westchester County Medical Center (WCMC) because of weakness of the lower extre- mities and bowel and bladder incontinence of 2-3 weeks’ duration. He had been an intravenous drug abuser and was diagnosed with AIDS 6 months pri- or to admission on the basis of biopsy-proven Pneu- mocystis carinii pneumonia. On admission to WCMC, the patient had a tem- perature of 38”C, blood pressure of 110/72 mm Hg., pulse rate of 78, and respirations of 20/min. Oral candidiasis was present. Neurologic examination revealed the patient to be awake, alert and oriented. Cranial nerve and up- per extremity examination was normal. He had flaccid paraplegia with only minimal movement at the hip joints. The deep tendon reflexes were pre- sent and equal in the upper extremities but absent in the lower extremities. The plantar responses were not elicitable. Position and pain sensations were normal. Peripheral white cell count was 8,000/mm3 with 58% polymorphonuclear leukocytes, 37% lympho- cytes, 6% eosinophils and 3% monocytes. The hemoglobin level was 14.2 g/dl and the hematocrit A chest roentgenogram was within normal limits. Computerized tomography of the brain and lumbar spine was normal. A lumbar puncture on admission showed turbid cerebrospinal fluid (CSF) with 340 erythrocytes/mm3, 410 white cells/mm3, 97% of which were polymorphonuclears, a protein of 500 42.1 zyxwv ‘/o.