Human T-cell lymphotropic virus 1 (HTLV-1) associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a neurological disease caused by infection with HTLV-1. The disorder is very rare in Europe but endemic in many parts of the world. The pathogenesis is not clearly characterized but is based on a possibly immune-mediated injury of the cervicothoracic spinal cord. Clinically, HAM/TSP constitutes a slowly progressive spastic paraparesis associated with bladder dysfunction and often mimics the course of autoimmune and neurodegenerative diseases. The diagnosis is based on typical symptoms as well as detection of HTLV-1 specific antibodies and proviral HTLV-1 DNA or HTLV-1 RNA. The therapy is limited to symptomatic treatment. Transmission of HTLV-1 can occur vertically by breast feeding, through sexual contact or via infected blood products. Based on a clinical case report, we present here a current review on the pathophysiology, epidemiology, clinical manifestations, diagnosis and treatment of HAM/TSP.