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This was a patient who had AIDS, who had gone

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off his retroviral...

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antiretroviral therapy.

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On the T1-weighted scan, we note a very large

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lesion which appears to extend from the upper

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thoracic region all the way down to the conus medullaris.

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The T2-weighted scan shows a relatively

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normal-appearing cervical spinal cord until

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we get to this intramedullary abnormality,

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which extends down to the conus medullaris.

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And it's also quite bright, obviously,

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on the STIR images as well.

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We see that the patient has enlarged palatine

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tonsils and lymphoid tissue,

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which is indicative of a patient

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who has HIV or AIDS as well.

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So what to do about this case?

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We want to look at the post-gadolinium

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enhanced sequences.

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So, on the post-gadolinium enhanced sequence, we

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see that there is relatively sparing of contrast

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enhancement in the upper thoracic region.

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But down at the cauda equina,

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we see peripheral enhancement.

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Let me see if I can move this around and blow it

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up and show you that enhancement

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to better advantage.

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So here we see at the distal-most portion of

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the spinal cord, we have peripheral contrast

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enhancement as well as non-enhancing

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center in this patient.

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So this is a case of a patient who has

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the risk factors of HIV and AIDS.

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HIV/AIDS patients can have any number of

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infectious inflammatory etiologies,

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including toxoplasmosis, as well as CMV,

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as well as herpes virus infections of the spinal cord.

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There is the entity known as vacuolar myopathy.

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This is a myelopathy,

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a lesion that can affect large segment of the spinal cord,

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tends to favor the more posterior aspect

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of the spinal cord and is unclear as far as its etiology,

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there are no pathogens that

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are associated with it.

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It may be part of the autoimmune transverse

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myelitis disorder that may be associated

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with the HIV itself.

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This ended up being vacuolar myelopathy

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in a patient with AIDS

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and no infectious agent was ever identified.