Spinal disease in neurologically symptomatic HIV-positive patients

We review the MRI findings of human immunodeficiency virus (HIV)-positive p atients with "spinal" symptoms and review the literature. In 23 consecutive HIV-positive patients presenting with acute neurologic complaints thought to be referable to the spine, we reviewed spinal MRI, medical charts, and l aboratory, pathologic, and autopsy data. In the early stages of HIV infecti on, the common causes of spinal complaints (i. e., degenerative spine and d isc disease) predominated. However, pathology may be missed without contras t-enhanced MRI of the spine. In more advanced cases, the differential diagn osis includes one or more neoplastic and/or infectious causes which require , contrast-enhanced MRI for detection. In these cases, normal cerebrospinal fluid findings should not preclude contrast-enhanced MRI of the spine. Ima ging of the brain may also be indicated in cases when the spinal study is n egative.