Presentation
A total of 107 articles reporting on 177 patients (108 articles and 178 patients with the present case) with epidural SALs were identified (Table 1).1–107 The average age for all patients (including the present case) was 46 ± 16 years, with a range of [ijssurgery.com]
Spinal angiolipomas cause a slow progressive clinical neurological presentation according to the level of the spinal canal compromised [1]. [scitcentral.com]
Case Report Presentation A 56-year-old male presented with history of numbness below the chest of 3 months duration and heaviness in bilateral lower limbs of 2 months duration and difficulty in walking for 2 months. [ncbi.nlm.nih.gov]
Case presentation Case 1 A 25-year-old Chinese woman with no significant medical history presented with lower back pain and left lower limb weakness and numbness for 1 year. [bmcresnotes.biomedcentral.com]
As the vessels are of low flow characteristics, flow void is not commonly seen; but will be a helpful hint if present. [radiopaedia.org]
Entire Body System
- Weight Gain
Angiolipoma occurs predominantly in women and obese people, and is more likely to be observed in pregnant women with sudden weight gain [8]. Pregnancy interferes with spinal venous drainage and increases epidural venous pressure. [jksgn.org]
Several predisposing factors were also suggested to be associated with SAL, such as weight gaining or hormonal changes in pregnancy [11] and elevated body mass index [10], however, systematic studies on the etiology of SALS are still lacking. [bmcresnotes.biomedcentral.com]
Cardiovascular
- Thrombosis
However, paraparesis or paraplegia may also occur acutely, particularly in the setting of tumor bleeding or thrombosis.2–6, 65, 96 A presumed diagnosis can be usually made by MRI, although the ultimate diagnosis is made with biopsy. [ijssurgery.com]
The occurrence of steal phenomenon, venous thrombosis, and hemorrhage can contribute to the development or sudden worsening of the symptoms [17,19,20]. [jksgn.org]
Sudden neurological deterioration can occur due to tumor thrombosis or hemorrhage.[6] Non-infiltrating angiolipomas are well defined and separate from the surrounding tissue and can usually be easily removed by laminectomy. [ncbi.nlm.nih.gov]
However, sudden deterioration can occur as a result of tumor thrombosis or hemorrhage, as reported in two different cases by Labram et al. [15] and Anson et al. [16] Pregnancy is an aggravating factor, and pregnancy termination may cause regression of [scitcentral.com]
It can evolve over a span of months to years, but occasionally sudden onset or worsening of neurological symptoms occurred when there is a rapid increase in tumor size due to intratumoral thrombosis, haemorrhage [7, 8]. [bmcresnotes.biomedcentral.com]
Neurologic
- Hyperreflexia
Neurological examination at 60 months follow-up revealed full power in the legs with normal tone and no hyperreflexia. [ncbi.nlm.nih.gov]
Patients who present with signs/symptoms of stenosis but with other concomitant findings such as hyperreflexia or spastic gait may require cervico-thoracic spine screening to rule-out spinal cord compression or disease. [ijssurgery.com]
Physical examination showed tendon hyperreflexia and reduced power in lower extremities with bilateral Babinski signs. A MRI scan revealed a spindle-shaped posterior epidural mass between T4 and T6, compressing the thoracic cord anteriorly. [bmcresnotes.biomedcentral.com]
- Babinski Sign
Physical examination showed tendon hyperreflexia and reduced power in lower extremities with bilateral Babinski signs. A MRI scan revealed a spindle-shaped posterior epidural mass between T4 and T6, compressing the thoracic cord anteriorly. [bmcresnotes.biomedcentral.com]
- Confusion
Case 1 can be easily confused with lipoma as it showed hyperintense in T2, reduced signal in fat suppressed T2, and no contrast enhancement. [bmcresnotes.biomedcentral.com]
Urogenital
- Incontinence
There was no urinary or stool incontinence. [scitcentral.com]
- Urinary Incontinence
There was no urinary or stool incontinence. [scitcentral.com]
Treatment
Even though, caution should be exercised in the treatment of elderly patients with spinal angiolipoma, surgical resection remains the recommended treatment for these patients. [jksgn.org]
According to the etiology, it will consist in: corticotherapy reduction and associated dietetic measures [9,12], treatment of the cause of the endogenous hypercorticism treatment [8] or weight reduction [6,13]. [docksci.com]
Si Y, Wang Z, Pan Y, Lin G, Yu T (2014) Spinal angiolipoma: Etiology, imaging findings, classification, treatment and prognosis. Eur Spine J 23: 417-425. 20. [scitcentral.com]
Spinal angiolipoma: etiology, imaging findings, classification, treatment, and prognosis. Eur Spine J 23:417-425. 2014. 16. Sim K, Tsui A, Paldor I, Kaye AH, Gaillard F. Four cases of spinal epidural angiolipoma. J Clin Neurosci 25:134-139. 2016. [e-neurospine.org]
The majority of patients underwent surgical treatment, achieving a gross total resection in most cases. Similarly, complete symptom resolution was the most common outcome. Conclusion Spinal angiolipomas are uncommon spinal tumors. [ijssurgery.com]
Prognosis
The prognosis is excellent for both non-infiltrating and infiltrating types. [scitcentral.com]
Spinal angiolipoma: etiology, imaging findings, classification, treatment, and prognosis. Eur Spine J 23:417-425. 2014. 16. Sim K, Tsui A, Paldor I, Kaye AH, Gaillard F. Four cases of spinal epidural angiolipoma. J Clin Neurosci 25:134-139. 2016. [e-neurospine.org]
Adjuvant radiation has not been recommended to patients with this benign pathological entity, since the prognosis is very good even in the infiltrating variety. [ncbi.nlm.nih.gov]
Spinal angiolipoma: etiology, imaging findings, classification, treatment, and prognosis. Eur Spine J 2014;23:417-25. 3. Akhaddar A, Albouzidi A, Elmostarchid B, Gazzaz M, Boucetta M. [jksgn.org]
Spinal angiolipoma: etiology, imaging findings, classification, treatment, and prognosis. Eur Spine J. 2014;23:417–25. Article PubMed Google Scholar Preul MC, Leblanc R, Tampieri D, Robitaille Y, Pokrupa R. Spinal angiolipomas. [bmcresnotes.biomedcentral.com]
Etiology
Spinal angiolipoma: etiology, imaging findings, classification, treatment, and prognosis. Eur Spine J 23:417-425. 2014. 16. Sim K, Tsui A, Paldor I, Kaye AH, Gaillard F. Four cases of spinal epidural angiolipoma. J Clin Neurosci 25:134-139. 2016. [e-neurospine.org]
Etiology and pathogenesis of spinal angiolipoma remain largely unknown. It was proposed that an insufficiency of blood supply in thoracic spine contributes to the thoracic predominance of SAL [9]. [bmcresnotes.biomedcentral.com]
Discussion The basic etiology of angiolipoma has not been elucidated yet [6]. It is a disease that mainly occurs in the subcutaneous tissue of the trunk and limbs. [jksgn.org]
Si Y, Wang Z, Pan Y, Lin G, Yu T (2014) Spinal angiolipoma: Etiology, imaging findings, classification, treatment and prognosis. Eur Spine J 23: 417-425. 20. [scitcentral.com]
According to the etiology, it will consist in: corticotherapy reduction and associated dietetic measures [9,12], treatment of the cause of the endogenous hypercorticism treatment [8] or weight reduction [6,13]. [docksci.com]