An Unusual Cause of Paraparesis in a Patient on Chronic Steroid Therapy

Gupta, Ranjan; Kumar, Arun; Gupta, Varun; Madhavan, Sethu M.; Sharma, S

doi:10.1080/10790268.2007.11753916

Cited by 23 publications

(24 citation statements)

References 11 publications

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“…In 1975, Lee et al 18) reported the first case of symptomatic epidural cord compression secondary to SEL. It is well known that the main etiological factors of SEL are associated with endocrine dysfunction such as Cushing disease, hypothyroidism, obesity, iatrogenic steroid treatment for immune disorders, COPD and transplantation 9,11,20,27) . In approximately 75% of SEL, this may be secondary to exogenous steroid ad- .…”

Section: Discussionmentioning

confidence: 99%

“…On physical examination, her body weight was 55 kg and height was 155 cm, her body mass index ministration for systemic diseases such as rheumatoid arthritis, systemic lupus erythematous, dermatomyositis, chronic obstructive pulmonary disease, or following organ transplantation 27) . Obesity is the second most common associated category of SEL 5,9,11) . Idiopathic SEL was first reported by Badami and Hinck 3) in 1982.…”

Section: Case Reportmentioning

confidence: 99%

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Idiopathic Thoracic Epidural Lipomatosis with Chest Pain

Lee

Park

Chang

et al. 2011

J Korean Neurosurg Soc

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was 22.8 kg/m 2 which was within the normal range. Neurologic examination revealed paresthesia on the left side, at the level of the T5 and T6 dermatomes, without myelopathy, motor weakness or claudication (Fig. 1). Hyperesthesia and allodynia were not evident. Laboratory evaluation, including full blood count, electrolytes, creatinine, liver function test, vitamin B12 and folate, urine analysis and culture, thyroid function tests, adrenocorticotropic hormone, and cortisol, were all unremarkable.Plain radiographs of the thoracic spine showed no abnormalities. Myelography computed tomography (CT) demonstrated a hypodense soft tissue mass within the posterior spinal canal and mainly in left vertebral foramen on T4/5 and 5/6 level ( Fig. 2).Magnetic resonance image (MRI) of the thoracic region presented a posterior compressing mass lesion of increased signal intensity on T1-weighted image (WI) and T2 WI in the epidural space, suggesting an epidural lipomatosis in the thoracic area. INTRODUCTIONSpinal epidural lipomatosis (SEL) is an overgrowth of the normally encapsulated adipose tissue in the epidural space around the spinal cord in the thoracic and lumbar spine causing compression of the neural components 5,12,13,25,26,32,34) . In cases without definite predisposing factors, the term 'idiopathic SEL' has been used. Idiopathic SEL in non-obese patients is exceptional 3,12,13,26) . According to previous reports, idiopathic SEL can result in thoracic myelopathy and lumbar radiculopathy 2,4,8,9,13,19) . To our knowledge, a thoracic radiculopathy due to idiopathic SEL has not been reported yet.We report a case of chest pain caused by idiopathic thoracic SEL in a female patient who did not have any other recognized predisposing factors for this condition. CASE REPORTA 16-year-old girl presented with a 2-month history of pain on her left chest. She reported that the pain spontaneously started around 2 months prior to admission and got worse over the two weeks. She could not do her usual daily living activities due to the intractable pain. She had no medical history for diabetes or steroid intake. On physical examination, her body weight was 55 kg and height was 155 cm, her body mass index Spinal epidural lipomatosis (SEL) is an overgrowth of the normally encapsulated adipose tissue in the epidural space around the spinal cord in the thoracic and lumbar spine causing compression of the neural components. Idiopathic SEL in non-obese patients is exceptional. Idiopathic SEL can result in thoracic myelopathy and lumbar radiculopathy. A thoracic radiculopathy due to idiopathic SEL has not been reported yet. We report a case of idiopathic SEL with intractable chest pain and paresthesia. We suggest that idiopathic SEL should be considered as a cause of chest pain.

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Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Idiopathic Thoracic Epidural Lipomatosis with Chest Pain

Lee

Park

Chang

et al. 2011

J Korean Neurosurg Soc

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“…Nevertheless, BMI does not reliably reflect the body fat composition [6,9]. Measurement of WC is a simple anthropometric measure and a good indicator of central obesity.…”

Section: Discussionmentioning

confidence: 99%

“…Age, gender and BMI of the cases were recorded. BMI [ 27.5 was considered to be obese [6,9]. The cutoff value of WC measurement was considered 95 cm for men,88 cm for women at which an increased relative risk for Turkish population were previously described [15,16].…”

Section: Patient Populationmentioning

confidence: 99%

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Does abdominal obesity cause increase in the amount of epidural fat?

2008

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It is known that epidural fat does not alter in obese people. This study aims to find out a possible relationship with epidural fat and abdominal obesity. In this cross-sectional study, 63 patients who were referred to our clinic for lumbar magnetic resonance imaging (MRI) examination were evaluated. Patients with the history of steroid treatment, thyroid disease or Cushing disease were excluded. Waist circumferences (WC), body weight and height were measured and subsequently body-mass index (BMI) was calculated (kg/m 2 ). On midsagittal T1-weighted images, anterior epidural fat (AEF), posterior epidural fat (PEF) and posterior subcutaneous fat (SCF) thicknesses were measured at the S1 level. The results were compared with age, gender, body weight, height, WC and BMI. There were 31 men and 32 women, age ranged 19-77 years (mean 49). The mean BMI was 29.25 kg/m 2 (20.7-52.7); the mean WC was 97.4 ± 13.2 cm (72-122) in women and 97.6 ± 9.8 cm (72-118) in men. Cutoff value of WC was considered as 88 cm for women and 95 cm for men. BMI [ 27.5 was considered to be obese. No statistical difference with respect to epidural fat thickness between genders was determined in AEF and PEF (P = 0.237, P = 0.616). SCF was significantly thicker in women (P = 0.021). A very poor and negative correlation was found between age and PEF (r = 0.373, P = 0.003), and a very poor and positive correlation between weight and PEF was found (r = 396, P = 0.001). The thickness of the epidural fat was not differ between obese and nonobese people (p = 0.571 for AEF and p = 0.307 for PEF). The thickness of the epidural fat was not different in people whose WC was greater than normal values in both gender (p [ 0.05). Epidural fat is not affected by age, gender, BMI and WC which means that epidural fatty layer. A clear correlation has not been found between epidural fat amount and obesity or abnormal fat distribution yet.

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Sudden paraplegia following epidural lipomatosis and thoracal compression fracture after long-term steroid therapy: a case report

et al. 2009

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Sudden paraplegia secondary to the posterior spinal epidural compression and vertebral compression fracture as a complication in corticosteroid treatment is extremely rare. The authors presented a case 49-year-old man with chronic relapsing attack of Still's disease. After the identification of pathology, the surgical evacuation of lipid tissue and pedicle-based instrumentation showed therapeutic success. To the authors' knowledge, this is the first case showing both vertebral fracture and paraplegia that required urgent surgery in the follow-up Still's disease.

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An Unusual Cause of Paraparesis in a Patient on Chronic Steroid Therapy

Cited by 23 publications

References 11 publications

Idiopathic Thoracic Epidural Lipomatosis with Chest Pain

Idiopathic Thoracic Epidural Lipomatosis with Chest Pain

Does abdominal obesity cause increase in the amount of epidural fat?

Sudden paraplegia following epidural lipomatosis and thoracal compression fracture after long-term steroid therapy: a case report

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