Idiopathic spinal epidural lipomatosis: urgent decompression in an atypical case

Abstract

Symptomatic spinal epidural lipomatosis (SEL) is very rare and frequently associated to chronic exogenous steroid use, obesity and Cushing syndrome. The idiopathic cases where no identifiable association with SEL are found constitute only 17% of all cases. The usual clinical manifestations of this entity consist of dorsal or lumbar pain with paresthesias and weakness in lower limbs, but acute symptoms of myelopathy are exceptional. We report a case of acute paraparesis and urinary retention caused by thoracic SEL in a 55-year-old male who did not have any recognized predisposing factor for this condition. Urgent surgical decompression was performed in order to relieve the symptoms. Slow but progressive improvement was assessed after surgery. We consider this case to be exceptional due to the needing to perform an urgent decompressive laminectomy to treat a rapidly progressive myelopathy caused by idiopathic SEL.

Fig. 1

Sagittal (a) and axial (b) T2-weighted MRI showing a hyperintense lesion, consistent with fat in the posterior aspect of the spinal canal (solid arrows) causing cord compression from T3 to T7 as well as a linear centromedullary cord area of high signal (open arrows) at the levels of compression

Fig. 2

Postoperative sagittal T2-weighted MR. It shows the decompressive laminectomy (between solid arrows) and a high signal corresponding to the anterior subarachnoid space (open arrows)