Spinal thoracic extradural angiolipoma manifesting as acute onset of paraparesis: Case report and review of literature

Abstract

Background:Angiolipomas are benign tumors most commonly found in the thoracic spine. They are composed of mature adipocytes and abnormal vascular elements that usually present with a slowly progressive course of neurological deterioration.Case Description:A 35-year-old female, with a prior history of back pain, acutely developed paraparesis. When the thoracic magnetic resonance imaging (MRI) revealed a dorsal epidural mass at the T3-T5 level, she underwent a laminectomy for gross total excision of the lesion that proved to be an angiolipoma. On the second postoperative day, the patient was again able to ambulate.Conclusion:The angiolipomas of spine are rare causes of spinal cord compression, and those presenting with acute neurological deficits should be immediately treated.

Epidural angiolipoma: A rare cause of spinal cord compression

“…The CT scan finding are not specific [ 15 ]. MRI is the most reliable examination for the diagnosis of SAL [ 16 ], showing a fatty tissu, typically hyper intense in T1 and T2 sequences. This tissue is trabeculated by vascular elements which enhance variably after contrast injection.…”

Hemorrhagic Sudden Onset of Spinal Epidural Angiolipoma

“…Akhaddar et al presented the first case of intraspinal bleeding from an epidural angiolipoma producing hyperacute paraplegia and simulating an extradural hematoma in 2008 [ 7 ]. Almost all the reported spinal angiolipomas with bleeding were located in the midthoracic region, and caused not only back pain or paresthesia but was also followed by paraplegia within a few minutes to a 1-week [ 7 – 10 ].…”

“…Differential diagnosis must include some epidural tumors and spinal epidural hematomas especially in the acute presentation. Heterogeneous hyperintensity to the spinal cord with focal hypointensity on T2-weighted imaging should suggest the diagnosis of acute spinal epidural hematoma [ 10 ]. Furthermore, all the cases of acute spinal epidural hematomas which needed emergent surgery in our institute (8 cases, from 2010 to 2016) showed a hypointense mass on T1-weighted imaging while the intensity on T2-weighted images seemed variable.…”

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

“…SEALs are benign tumors comprising of both mature fatty tissue and anomalous vascular rudiments. The above features make these lesions clinically and pathologically unique (3,5). SEALs are classified into two subtypes: non-infiltrating and infiltrating (5)(6)(7).…”

“…The above features make these lesions clinically and pathologically unique (3,5). SEALs are classified into two subtypes: non-infiltrating and infiltrating (5)(6)(7). While the non-infiltrating types are more common and normally well encapsulated, the infiltrating types are sporadic, and usually unencapsulated with imprecise edges.…”