Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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February 28, 2011
Idiopathic Lumbosacral Epidural Lipomatosis
- Epidural lipomatosis refers to abnormal accumulation of epidural fat, which often causes thecal sac compression.
- Exogenous corticosteroid therapy and Cushing's syndrome are common etiologies. Antiretroviral (HAART) therapy, obesity, and idiopathic etiologies are less common etiologies.
- Most often the mid to distal thoracic spine is involved. Involvement of the lumbosacral spine is also common.
- Patients with epidural lipomatosis usually present with weakness, decreased sensation and reflexes, and mild back pain. Alterations in bowel and bladder function are uncommon.
- Key Diagnostic Features: MR is the imaging modality of choice. Abnormal accumulation of epidural fat causing variable degree of thecal sac compression is seen. Axial MR imaging demonstrates a 'Y' shaped configuration of the thecal sac, termed the 'Y' sign.
- DDx: Epidural hematoma, Spinal angiolipoma
- Treatment: Discontinuation of steroids, surgery