Rare case of SEL

1. RESEARCH POSTER PRESENTATION DESIGN © 2019
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INTRODUCTION
CASE REPORT
A Spinal epidural lipomatosis is a rare and complex disorder of
enlaged epidural adipose tissue encroaching spinal canal and
compressing neural elements causing progressive neurological
deficits.1 Hypertrophied epidural fat is most commonly associated
with long term steroid usage and conditions like cushings
syndrome , Obesity or can be idiopathic.
A 21 yrs gentleman presented to emergency department with the
chief complaint of not able to move his both legs for the past 3
months. He was apparently normal 2yrs back, later he noticed
numbness and tightness of both lower limbs, gradually he had
difficulty in walking and he consulted a neurologist ,he was given
steroids in view of demyelination , patient had complete recovery
for 3 months, again he had weakness in both lower limbs. He had
such relapsing & remitting episodes of paraparesis until January
2021 , this time patient again consulted neurologist and was
treated with steroids but did not have improvement. Bowel and
bladder control were normal.
On motor examination power in both lower limbs was 0/5,
showing spasticity & exaggerated deep tendon reflexes in both
lower limbs , with extensor plantar response. Sensory
examination showed all sensations decreased below D3 level.
Patient weighed 70kgs and his height was 165cms and his BMI
was 25.7. Hormone profile, Vit B12 level, vasculitis workup , csf
analysis & nerve conduction studies were normal . MRI showed
prominent epidural fat from D1 to D6 level with maximum
compression at D3-D4 Level .Patient underwent
C7-D7 decompressive laminectomy and epidural fat debulking .
Postop day 2 he gained power upto 2/5, finally he was able to
walk with support after 1 month.
DR J DHEERAJ, DR B HANUMA SRINIVAS, DR B CHANDRA SHEKHAR, DR D SESHADRI SEKHAR
SPINAL EPIDURAL LIPOMATOSIS: HAS THIS CASE ONCE AGAIN GIVEN OPPORTUNITY TO PROVE “DOCTORS ARE DEMIGODS”?

2. RESEARCH POSTER PRESENTATION DESIGN © 2019
www.PosterPresentations.com
Spinal epidural lipomatosis is characterized by abnormal deposition of
un-encapsulated fat in epidural space.2 In this case patient presented
with 3 months of paraplegia and was planned for dorsal
decompressive laminectomy and debulking of epidural lipomatosis in
April 2021,but tested positive for covid-19 ,1 day prior to the surgery.
So he was treated for covid-19 and the surgery was performed in July
2021. This case is particularly interesting in view of two important
factors, the diagnostic ambiguity because of the relapsing and
remitting episodes of weakness and his clinical picture getting
improved with steroids every time until january 2021 , the patient not
being obese and his hormonal profile being normal makes the
diagnosis of epidural lipomatosis even more difficult. The second
distinct feature being the prolonged duration of paraplegia for 7
months making the postop recovery doubtful . But on post-op day 2
he gained power upto 2/5, and he was able to walk with support after
1 month and continues to do so.
DISCUSSION
CONCLUSION
In this case scenario final outcome is good
inspite of prolonged paraplegia. Usually
surgeons hesitate to proceed with surgery with
such long duration of paraplegia. In this case
patient has given the credit to surgeon, but
surgeon will attribute this credit to
Neurologist, whereas Neurologist has given
this credit to patient, finally once again nature
has given opportunity to prove “Doctors are
Demigods””.

3. RESEARCH POSTER PRESENTATION DESIGN © 2019
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References
1. Fassett DR, Schmidt MH. Spinal
epidural lipomatosis: a review of its
causes and recommendations for
treatment.
Neurosurg Focus. 2004;16:E11.
2. Al-Khawaja D, Seex K, Eslick GD.
Spinal epidural lipomatosisa brief
review. J Clin Neurosci.
2008;15:1323–1326.