Amir Awwad1,2, Renan E Ibrahem Adam3, Chandni Patel4, James D Thomas3. 1. 1NIHR Nottingham Biomedical Research Centre, Sir Peter Mansfield Imaging Centre (SPMIC), University of Nottingham, Nottingham, NG72UH UK. 2. 2Radiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, CB23 3RE UK. 3. 3Radiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH UK. 4. 4Urology Department, Nottingham Urology Centre, City Hospital, Nottingham, NG5 1PB UK.
Abstract
INTRODUCTION: Spinal epidural lipomatosis (SLE) is an abnormal accumulation of unencapsulated fat. The association of chronic steroid therapy is described as well as obesity and Cushing's syndrome. SLE has a range of neurological presentations such as back pain, myelopathy, and cauda equina syndrome. Surgical decompression is known to improve symptomatic cases and prevent further deterioration. CASE PRESENTATION: An elderly male patient with background history of high-risk metastatic prostate cancer and long-term treatment with steroids and hormonal therapy presented with acute on chronic back pain and neurological symptoms. Spinal cord compression was excluded on the subsequent MRI. However, a spinal epidural lipomatosis causing significant central canal stenosis and compression of the cauda equine was revealed. DISCUSSION: With the increasing role of MRI in assessing back pain, asymptomatic spinal epidural lipomatosis has been frequently noticed. However, symptomatic presentation after long term combined treatment of steroids and hormonal therapy has not been reported in the literature.
INTRODUCTION: Spinal epidural lipomatosis (SLE) is an abnormal accumulation of unencapsulated fat. The association of chronic steroid therapy is described as well as obesity and Cushing's syndrome. SLE has a range of neurological presentations such as back pain, myelopathy, and cauda equina syndrome. Surgical decompression is known to improve symptomatic cases and prevent further deterioration. CASE PRESENTATION: An elderly male patient with background history of high-risk metastatic prostate cancer and long-term treatment with steroids and hormonal therapy presented with acute on chronic back pain and neurological symptoms. Spinal cord compression was excluded on the subsequent MRI. However, a spinal epidural lipomatosis causing significant central canal stenosis and compression of the cauda equine was revealed. DISCUSSION: With the increasing role of MRI in assessing back pain, asymptomatic spinal epidural lipomatosis has been frequently noticed. However, symptomatic presentation after long term combined treatment of steroids and hormonal therapy has not been reported in the literature.
Authors: Steven C Kirshblum; Stephen P Burns; Fin Biering-Sorensen; William Donovan; Daniel E Graves; Amitabh Jha; Mark Johansen; Linda Jones; Andrei Krassioukov; M J Mulcahey; Mary Schmidt-Read; William Waring Journal: J Spinal Cord Med Date: 2011-11 Impact factor: 1.985
Authors: Moshe Praver; Benjamin C Kennedy; Jason A Ellis; Randy D'Amico; Christopher E Mandigo Journal: J Clin Neurosci Date: 2015-06-09 Impact factor: 1.961