Spinal epidural lipomatosis and angiolipoma

The authors describe two clinical observations of spinal epidural lipomatosis in the thoracic spine: in a 51-year-old slim man with asymmetric spastic paraparesis of the lower extremities and in a 46-year-old obese man with the algic root syndrome of Th-5. In the first case the epidural lipomatosis was combined with dorsal protrusion of the Th6-7 disc which led to segmental ischaemia with atrophy of the spinal cord. In the second observation the lipomatosis was combined with angiolipoma at the level of Th4-5, not confirmed by histological examination. The root syndrome of Th-5 receded after body weight reduction. Spinal epidural lipomatosis develops in endocrinopathies, as a result of prolonged corticoid therapy, due to obesity and for unknown reasons (idiopathic). The pillar in the diagnosis of spinal epidural lipomatosis and angiolipomas are radiological findings, in particular magnetic resonance tomography (MRT). The hypertrophic adipose tissue layer, preferably located in the dorsal epidural space of the spine is visualized by increased signal intensity in T-1 sequences. Angiolipomas are hyperintense in T-1 images with iso or hypointense areas which correspond to vascular elements. Clinical symptoms of spinal epidural lipomatoses and angiolipomas are similar - local spinal pain and rarely root pain, spastic or peripheral paraparesis of the lower extremities, paresthaesias and impaired sensitivity of the cordal or root type. Treatment of both afflictions is conservative or surgical. In spinal epidural lipomatoses conservative treatment predominates - discontinuation of corticoid therapy and a reducing diet. In angiolipomas decompressive surgical treatment predominates, in selected cases a reducing diet may be successful.