A 56 y.o. male presents with paraplegia

His MRI is shown below

what is wrong?

Our patient was paraplegic because of spinal epidural lipomatosis. There is proliferation of fatty tissue in the spinal canal which compresses the cord. The first case was reported in 1975.  Many of the cases are due to long term use of steroids but it has also been associated with Cushings, hypothyroidism, prolactinoma and obesity. It has even been reported after epidural spinal injections.

Back pain is the initial presenting symptom. This is followed by lower extremity weakness and only rarely is incontinence reported. Since there is no fat in the cervical spine; symptoms are most often in the lower extremities.

Treatment can range from weight loss to surgical debulking of fat in the canal. Our patient was recognized late and was already paraplegic so no intervention was performed.

Rustom D, Gupta D, Chakrabortty S. Epidural lipomatosis: a dilemma in interventional pain management for the use of epidural steroids. J Anaesthesiol Clin Pharmacol. 2013;29:410-411

Fassett, D, Schmidt M.Spinal epidural lipomatosis: a review of its causes and recommendations for treatment. Neurosug Focus 16(4): Article 11, 2004. 1-3.