Idiopathic Spinal Epidural Lipomatosis: Unusual Presentation
Epidural lipomatosis (EL) is a pathology characterized by abnormal accumulation of unencapsulated fat in the epidural space. Although rare, it is a possible cause of lumbosciatica or narrow lumbar canal in adults. It is often associated with favorable factors such as prolonged corticosteroid therapy or obesity. An 18-month-old child, the youngest of the two siblings; his parents were not consanguineous, and had no history of maternal drug intake, hypothyroidism, or other diseases; the child was born by vaginal delivery, in a term without perinatal asphyxia, and the birth weight was 3200 g.

The patient's psychomotor development was normal until the age of one year; he crawled and can stand with assistance, but he presented a gait delay without other associated signs especially no amyotrophy or orthopedic deformations. General physical examination was normal with no evidence of facial dysmorphism, pulse rate of 85, and respiratory rate of 23; his growth was normal with a weight of 12kg (M), height of 81cm (+1 standard deviation), and head circumference of 46cm (-1 standard deviation).

Neurological examination showed a reactive patient, standing with support; deep tendon reflexes were decreased, the plantar reflex was indifferent to both feet, the tone was normal, and two blue spots of 1 cm were seen on the seat and foot.

The assessment consisted of electromyography (EMG): without anomalies, the thyroid-stimulating hormone (TSH) level: normal (2,421UI/ml and T4: 13.26pmol/l); and creatine phosphokinase (CPK): normal (109 U/l). It is not in favor of myopathy. So, the flaccid pyramidal syndrome was suspected, and a cerebral spinal magnetic resonance imaging (MRI) revealed infiltration fat of distal lumbar epidural reducing the scabbard and dural bag, and the level of the medullary cone is located in L1-L2 in favor of epidural lipomatosis.

Searching for other associated neurological abnormalities, the urodynamic assessment was normal and the etiological investigation showed a normal rate of triglycerides (0.36g/l) and total cholesterol (1.4g/l). The patient management consisted of motor physiotherapy with regular follow-up in consultation of neurosurgery, with a stationary evolution, and currently, walking is not yet acquired. The walking delay is the only inaugural symptom without peripheral neurological cause or myopathy, and no urodynamic disorders were observed.