Neurologic prognosis of cytomegalovirus polyradiculomyelopathy in AIDS

Neurology. 1993 Mar;43(3 Pt 1):493-9. doi: 10.1212/wnl.43.3_part_1.493.


Cytomegalovirus (CMV) polyradiculomyelopathy is an uncommon but distinctive clinical syndrome in HIV-infected patients in which ascending motor weakness, areflexia, loss of sphincter control, paresthesias, and varying sensory impairment develop subacutely in association with a polymorphonuclear pleocytosis, increased protein, and hypoglycorrhachia in CSF. Responses to treatment with ganciclovir have varied in reported cases. We report three additional cases: two of these patients responded to treatment and the third was demonstrated to have CMV resistant to ganciclovir. We review other reported cases and identify factors predictive of ganciclovir resistance, which include persistent polymorphonuclear pleocytosis and hypoglycorrhachia on serial CSF studies, and positive CMV cultures from CSF or blood after induction therapy. We conclude that ganciclovir may be an effective therapy for CMV polyradiculomyelopathy, but the presence of these factors, or the development of the syndrome in a patient already being treated with ganciclovir, should prompt consideration of alternative antiviral therapy.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / cerebrospinal fluid
  • AIDS-Related Opportunistic Infections / complications*
  • AIDS-Related Opportunistic Infections / drug therapy
  • Acquired Immunodeficiency Syndrome / cerebrospinal fluid
  • Acquired Immunodeficiency Syndrome / complications*
  • Acquired Immunodeficiency Syndrome / drug therapy
  • Adult
  • Cytomegalovirus Infections / cerebrospinal fluid
  • Cytomegalovirus Infections / complications*
  • Cytomegalovirus Infections / drug therapy
  • Ganciclovir / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Spinal Cord Diseases / cerebrospinal fluid
  • Spinal Cord Diseases / complications*
  • Spinal Cord Diseases / drug therapy
  • Spinal Nerve Roots*


  • Ganciclovir