CMV polyradiculomyelopathy

Cytomegalovirus (CMV) Polyradiculomyelopathy is a severe neurological condition associated with Cytomegalovirus (CMV) infection, primarily affecting the spinal cord's nerve roots. This condition is characterized by progressive weakness, sensory loss, and in severe cases, paralysis and incontinence. CMV polyradiculomyelopathy is most commonly seen in individuals with compromised immune systems, such as those with AIDS or organ transplant recipients.

Etiology

CMV polyradiculomyelopathy results from the direct infection of the spinal cord's nerve roots by the CMV virus. CMV is a type of herpesvirus that remains dormant in the body after initial infection and can reactivate in cases of immunosuppression.

Pathophysiology

The CMV virus targets the peripheral nerves and the spinal cord, leading to inflammation and damage to the nerve roots (polyradiculopathy) and the spinal cord (myelopathy). This damage results in the disruption of nerve signals between the brain and the rest of the body.

Clinical Presentation

Patients with CMV polyradiculomyelopathy typically present with rapidly progressing lower extremity weakness, back pain, sensory loss, and areflexia. Autonomic dysfunction may also occur, manifesting as urinary retention or incontinence and constipation.

Diagnosis

Diagnosis of CMV polyradiculomyelopathy involves a combination of clinical assessment, MRI of the spine, and laboratory tests. Lumbar puncture to analyze cerebrospinal fluid (CSF) for the presence of CMV DNA through polymerase chain reaction (PCR) is crucial for confirmation.

Treatment

Treatment focuses on antiviral therapy to combat the CMV infection, typically involving medications such as ganciclovir or foscarnet. Early initiation of treatment is critical to prevent further neurological damage and improve outcomes.

Prognosis

The prognosis for patients with CMV polyradiculomyelopathy varies. Early and aggressive treatment can lead to partial or complete recovery; however, delayed treatment may result in permanent neurological deficits.

Prevention

Preventive measures include regular monitoring for CMV infection in high-risk individuals and preemptive antiviral therapy in cases of detected reactivation before the onset of symptoms.