Extensive Extradural Lipomatosis / Lipomatose Extradural Extensiva

Abstract

A male patient presents with urinary incontinence with worsening in the last year, shock sensation, symmetrical weakness and involuntary spasms in the lower limbs. He currently required double support to ambulate and had no sphincter control. Neurological examination demonstrated lower limb hypertonia and spastic paraplegia with severe impairment of deep sensation and painful muscle spasms. The patient and had normal body mass index and laboratory tests excluded endocrinopathies. MRI showed myelopathy caused by hyperintense tissue with suppressed T1 signal in the epidural space, representing fatty tissue and extensive hyperintensity in the upper portion of the thoracic spinal cord. Axial T2-weighted imaging confirmed fatty tissue in the epidural space between the T3 and T7 levels, promoting markedly narrowed dural sac and spinal cord compression. The case was then compatible with idiopathic lipomatosis and surgery was indicated. The patient did not agree and was lost to follow-up.