HIV-related vacuolar myelopathy

HIV-related vacuolar myelopathy, also known as AIDS-related myelopathy, is the most common chronic myelopathy associated with HIV infection and is typically seen in the late stages of the disease.

Clinical presentation

Patients tend to have slowly progressive weakness of the lower extremities, gait disorders, sensory abnormalities in the lower limb, impotence, urinary frequency and urgency .


HIV-infected mononuclear cells secrete neurotoxic factors. Another contributing factor may be the impaired ability to use vitamin B12 as a source of methionine in transmethylation metabolism for myelin in the spinal cord (which may explain why findings are similar to those in subacute combined degeneration).

Radiographic features

  • spinal cord atrophy is the most common finding, typically involving the thoracic cord; cervical cord may also be involved
  • bilateral symmetric dorsal column involvement can be seen: similar to subacute combined degeneration
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