ACUTE LUMBOSACRAL POLYRADICULOPATHY IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME - EXPERIENCE IN 23 PATIENTS

We reviewed our experience in 23 patients with acquired immunodeficien cy syndrome (AIDS) who had acute lumbosacral polyradiculopathy. The pa tients developed a distinctive syndrome of rapidly progressive flaccid paraparesis and areflexia that was frequently associated with sphinct er disturbances. Persuasive laboratory evidence of a cytomegalovirus p olyradiculopathy (polymorphonuclear pleocytosis or confirmatory cerebr ospinal fluid culture) was found in 15 of the 23 patients. Treatment w ith ganciclovir in these patients led to clinical stabilization, altho ugh worsening during the first 2 weeks of treatment was common. Most p atients with cytomegalovirus polyradiculopathy had severe residual def icits. Metastasis from systemic lymphoma accounted for the polyradicul opathy in 2 other patients. A more benign syndrome was identified in t he remaining 6 patients. They generally had slower clinical progressio n and less severe neurological deficits at their nadir than did patien ts with cytomegalovirus polyradiculopathy. Unlike patients with cytome galovirus infection, their cerebrospinal fluid showed a predominantly mononuclear pleocytosis. Moreover, spontaneous improvement without tre atment was common. Our experience together with the published experien ce of others suggests chat the acute lumbosacral polyradiculopathy in AIDS is a clinical syndrome with different etiologies and variable cli nical outcome. Recognition of this heterogeneity is necessary for the management of individual patients, as well as the interpretation of tr eatment results.