Symptoms of HIV associated vacuolar myelopathy
Patients experience a clinical picture similar to subacute combined degeneration seen in vitamin B12 deficiency.
Affected spinal cord tracts include the dorsal columns and the corticospinal tract, resulting in spastic paraparesis without sensory level but with sphincter dysfunction along with sensory ataxia and impaired proprioception and vibration in the lower extremities.
Reflexes are typically increased but may be diminished at the ankles due to concurrent HIV neuropathy.