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LETTERS TO THE EDITOR

Spinal Anesthesia in Human T Lymphotropic Virus Type I-Associated Myelopathy

Department of AnesthesiaKinki University School of Medicine Sakai HospitalOsaka, Japan Department of AnesthesiologyKinki University School of MedicineOsakasayama, Japan

To the Editor:

We performed spinal anesthesia in a patient with human T lymphotropic virus type I (HTLV-I)-associated myelopathy (HAM). It has not been previously reported that spinal anesthesia was used for HAM. Epidemiologically, HAM exists in a high frequency of HTLV-1 carriers and is common in Japan and the Caribbean, but there are few patients in the United States (1).

A 60-yr old man with HAM was admitted for cystolithotomy. He had suffered from urinary bladder disturbance, muscle weakness, and involuntary motion of the lower extremities. The diagnosis of HAM was based on the clinical findings and the presence of antibody against HTLV-I in serum and cerebrospinal fluid. Spinal anesthesia was achieved by administration of 10 mg tetracaine and 40 µg buprenorphine in 10% dextrose. Anesthesia proceeded uneventfully. Postoperatively, neurological findings revealed no deterioration of the signs of HAM and his hospital course was uncomplicated.

There are a few reports of spinal anesthesia performed in patients with neurologic disease, such as multiple sclerosis (2) and Friedreich’s ataxia (3). They did not show exacerbation of their symptoms in the postoperative period. Our patient with HAM also showed no change in symptoms. This case suggests that spinal anesthesia can be applied in cases of HAM.

References

1. Sheremata WA, Berger JR, Harrington WJ Jr, et al. Human T lymphotropic virus type I-associated myelopathy: a report of 10 patients born in the United States. Arch Neurol 1992; 49: 1113–8.[Abstract/Free Full Text]
2. Kytta J, Rosenberg PH. Anaesthesia for patients with multiple sclerosis. Ann Chir Gynaecol 1984; 73: 299–303.[Web of Science][Medline]
3. Kubal K, Pasricha SK, Bhargava M. Spinal anesthesia in a patient with Friedreich’s ataxia. Anesth Analg 1991; 72: 257–8.[Web of Science][Medline]

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