Diagnostic workup

A patient may be suspected of having HIVM if he has a spastic-atactic gait, hyper-reflexia with positive Babinski sign, disturbance of sphincter control, erectile dysfunction, and slight signs of sensory dysfunction in a glove and stocking distribution. The diagnosis of an independent HIVM should only be made when concomitant cognitive impairment is significantly less prominent than myelopathy. Electro-physiological tests, which show increased latencies of somatosensory evoked potentials (SEP) and motor evoked potentials on transcranial magnetic stimulation, are compatible with the diagnosis. CSF, microbiological and spinal imaging studies are inconspicuous or unspecific, and they have their importance in the exclusion of differential diagnoses, as listed in Table 4. Spinal imaging should include MRI of the cervical and, possibly, the thoracic cord.

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