Symptomatic spinal epidural lipomatosis as a complication of steroid immunosuppression in cardiac transplant patients

Report of two cases

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✓ Patients with Cushing's syndrome may develop spinal epidural lipomatosis, an abnormal accumulation of fat in the spinal epidural space. This accumulation of fat may cause compression of the spinal cord or cauda equina with resulting neurological deficit. Two cases of symptomatic spinal lipomatosis are reported in cardiac transplant patients receiving chronic corticosteroid treatment. The literature is reviewed, and diagnostic and therapeutic considerations are discussed.

Article Information

Address reprint requests to: Richard B. Morawetz, M.D., Division of Neurosurgery, MEB 510, University of Alabama Medical Center, Birmingham, Alabama 35294.

© AANS, except where prohibited by US copyright law.

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    Case 1. Lateral myelogram demonstrating compression deformity of variable severity involving the T4–9 vertebral bodies. The anterior extradural deformity at the T9–10 level is attributed to spondylosis. Compression of the subarachnoid space begins at T-9 and extends cephalad to T-7, where an apparent complete block is encountered.

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    Case 1. Computerized tomography scan at the T8–9 level. Contrast material is visible in the subarachnoid space. The thecal sac is compressed by a posteriorly located low-attenuation mass. The attenuation number here was −125 Hounsfield units.

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    Case 2. Myelograms of the thoracolumbar area. Left: On the supine view, extradural compression of the subarachnoid space becomes severe at the T10–11 level. Wire sternotomy sutures overlie the area of interest. Right: On the lateral view, compression of the subarachnoid space is seen to be due to a posteriorly located mass (arrows).

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    Case 2. Computerized tomography scans of the thoracic region: T-6 level (upper left), T-7 level (lower left), T-7 level (upper right), T-8 level (lower right). A low-attenuation posterior extradural mass compresses the subarachnoid space. Attenuation numbers in the mass in this region were −148, −117, −109, and −97, which suggest the presence of fat.

References

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