Syringohydromyelia or HTLV-I-associated myelopathy/tropical spastic paraparesis: a diagnostic challenge (case report)

human t-cell lymphotropic virus type i (htlv-i) associated myelopathy / tropical spastic paraparesis (ham/tsp) is the most common chronic myelopathy in brazil. we present the case of a 53 year old man that fulfilled the diagnostic criteria for ham/tsp but had at the magnetic resonance imaging (mri) of the spinal cord evidences of syringohydromyelia at the c6-c7 and d2-d7 levels along with chiari type 1 malformation. the clinical picture was more typical of ham/tsp than of syringohydromyelia, which was probably asymptomatic. the present case clearly demonstrates that serology and neuroimaging should be always used together. we conclude that, specially in places where htlv-i is endemic, every patient with a spastic paraparesis, even with a radiological picture suggestive of a structural spinal cord lesion, should have a screening test for htlv-i. the clinical picture must dictate the final direction of the diagnosis.