Spinal epidural lipomatosis: a case study.

Publication: Journal of Neuroscience Nursing

Publication Date: 01-AUG-04

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COPYRIGHT 2004 American Association of Neuroscience Nurses

Abstract; Spinal epidural lipomatosis (SEDL), an abnormal localized or tumor-like accumulation of fat in the epidural space, is an infrequent complication of chronic steroid usage and an uncommon cause of spinal cord compression. A patient with a primary malignant brain tumor on chronic corticosteroids presented with a clinical picture of cord compression and was diagnosed with SEDL.

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Mrs. D., a 55-year-old white female, presented to the hospital with a 2-week history of decreased motor strength and function in her lower extremities, mid-back pain, urinary retention, and, at the time of admission, an inability to bear weight. A magnetic resonance imaging (MRI) scan revealed a large fat density in the posterior thoracic area stretching from T2-10 with maximal cord compression at T6-7. Although the most common cause of cord compression is some type of tumor, that is not always the case. This case presentation provides an example of an unusual cause of cord compression and unique issues relating to chronic but necessary corticosteroid usage and underlying neurologic deficits.

Assessment

Mrs. D's decreasing motor strength in her lower extremities progressed over 2 weeks prior to admission, and she was unable to bear weight. She had 0/5 motor function below the level of T8 and decreased patchy sensation beginning at T8 and going into her lower extremities. Reflexes in her lower extremities were absent. She was experiencing severe pain in her mid back with radiation to her chest with a band-like sensation, characteristic of spinal cord compression. She had an indwelling urinary catheter placed for urinary retention. Not to be overlooked are her neurological deficits from her brain tumor. Mrs. D. has mild to moderate global aphasia, a right visual field cut, and a mild right pronator drift.

Past History...

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