Hemorrhagic Sudden Onset of Spinal Epidural Angiolipoma

Abstract

Angiolipomas are relatively rare benign tumors. Spinal angiolipomas that generally induce slow progressive cord compression are most commonly found in the thoracic region. A 49-year-old female with obesity presented with a 1-week history of progressively worsening back pain, paresthesia of lower limbs, and gait disturbance. When thoracic magnetic resonance imaging (MRI) revealed a dorsal epidural mass at the Th5–Th8 level, the patient underwent a laminectomy for gross total excision of the lesion. Both mature fatty tissue and abnormal proliferating vascular elements with thin or expanded walls were observed in the resected tumor. Nonfiltrating spinal angiolipoma was diagnosed and confirmed by pathology. After the operation, sensory loss, numbness, and gait disturbance were improved following the disappearing severe back pain. Following examinations indicated the absence of recurrence within 1 year. The angiolipomas of the spine are rare causes of spinal cord compression that generally induce slow progressive cord compression, but sudden onset or rapid worsening of neurological deterioration is observed in hemorrhagic spinal angiolipoma.

Medical and Legal Implications of MRI Scout Imaging in a Surgical Patient with Case Presentation

“…In this case the final pathology was angiolipoma. While considered a benign lesion, neurologic decline can occur with hemorrhage, intratumoral thrombosis, or steal phenomenon [4][5].…”

Spinal angiolipoma: a report of two cases and review of the literature

“… 22 , 26 , 27 Critical onset or aggravated neurological symptoms occur if the lesion grows rapidly because of tumor thrombosis and/or hemorrhage. 28 – 31 …”

“…22,26,27 Critical onset or aggravated neurological symptoms occur if the lesion grows rapidly because of tumor thrombosis and/or hemorrhage. [28][29][30][31] X-rays of the spine often show negative results in patients with SALs, but might show erosion of the walls of the bodies and pedicles as a result of infiltrating tumors. 8,32 Myelography was performed in some cases and showed a characteristic posterior extradural spinal lesion with partial or complete filling defect.…”

Spinal epidural angiolipoma: a case report on sudden hemorrhagic onset and review of the literature

“…This was a case of a 47-year-old male who developed sudden paresthesia and complete neurological palsy within a few minutes due to the hemorrhagic epidural angiolipoma. In 2018 Horiuchi et al [4] reported the case of a 49-yearold female with obesity (BMI, 31.1 kg/m 2 ) who presented with a 1-week history of progressively worsening back pain, paresthesia of the lower limbs, and gait disturbance. Surgery was performed and angiolipoma was diagnosed on the pathological examination after surgery.…”

“…Most spinal angiolipoma are expressed at the thoracic level and are associated with signs of cord compression as they enlarge slowly, therefore, a sudden deterioration in symptoms does not occur. However, hemorrhagic transformation of angiolipoma, although rare, may cause sudden worsening of neurological symptoms [3][4][5]. Unfortunately, it is difficult to differentiate these cases from simple hematoma.…”