idyopatik Spinal Epidural Lipomatozis: Olgu .Anahtar Kelimeler : Epidural lipomatozis, radikulopati,

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Text of idyopatik Spinal Epidural Lipomatozis: Olgu .Anahtar Kelimeler : Epidural lipomatozis, radikulopati,

Turk NOTO$irulji Dergisi 5: 82 - 85, 1995 Atabey: idyopatik Spinal Epidural Lipomatozis

idyopatik Spinal Epidural Lipomatozis:Olgu Sunumu

Idiopathic Spinal Epidural Lipomatozis:A Case Report

RAMAZAN ATABEY, TALAT KIRIS, NEVRA SiSLi, BULENT DEMiRGiL, HALiL TOPLAMAOGLU

Baklrkoy Ruh ve Sinir Hastahklan hastanesi Ill. Noroirurji Klinigi, istanbul

Ozet: idyopatik spinal epidural lipomatozis lomber radikulo-patinin aymCl tamsmda akilda bulundurulmasl gereken birhastahktlr. Epidural lipomatozisin uzun sureli kortikosteroidkullamml ve endojen hiperkortizolemi sonucu oluabildigibilinmekle birlikte idyopatik formu son derece nadirdir.Bu makalede radikulopatiyle bavuran ve spinal epidural lipo-matozis tamsl konularak ameliyat edilen bir olgu sunulmu vedaha once yaymlanml olgular gozden ge~irilerek tartlrlmltlr.

Anahtar Kelimeler : Epidural lipomatozis, radikulopati, kor-tikosteroid, laminektomi

coosKlinikte nadir bir hastahk olarak gorulen

spinal epidural lipomatozis spinal kanalda epiduralmesafede yag dokusunun anormal miktarda birik-mesi durumudur. Ce~itli medikal sorunlar nedeni-

yle uzun sureli kortikosteroid kullamml ve endojenCushing sendromuna bagh olarak gorulebilecegigibi literaturde etyolojisi saptanamayan birka;: olguda bildirilmi~tir (3,4,5,9,11).

Burada bel agnsl ve radikuler yakmmalarlaba~vuran, yapllan tetkiklerinde idyopatik spinalepidural lipomatozis saptanarak cerrahi giri~imletedavi edilen bir olgu sunulmu~ ve bu konuyla ilgililiteratur gozden ge;:irilmi~tir.

OLCUSUNUMU

30 ya~mda bayan hasta bel ve solda fazla 01-mak uzere her iki bacakta agn ~ikayetiyle ba~vurdu.Oykusunde bel agnsl ~ikayetinin bq yll once

Summary: Idiopatic spinal epidural lipomatosis should be COll-sidered in the differential diagnosis of lumbar radiculopathy.Although spinal epidural lipomatosis is a well-recognized com-plication of endogenous and exogenous hypercortisolism , theidiopathic form isvery rare.In this article we report a case of spinal epidural lipomatosis withthe presenting complaint of lumbar radiculopathy. We also re-viewed the previously published cases and discussed the pre-dominant features of these cases.

Key Words : Epidural lipomatosis, radiculopathy, corticoster-oid, laminectomy

ba~ladlgl, buna u;:YIl once sol bacak, iki ay once desag bacak agnsmm eklendigi, yatak istirahati, medi-kal tedavi ve fizik tedaviden yarar gormedigi belir-tiliyordu. Hastanm ozge;:mi~inde herhangi birhastahk ve ila;:kullamml oykusu yoktu.

Muayene: Hasta 1.63m boyunda, 66 kgaglrhgmdaydl. Sistemik muayenesinde ozellik yoktu.Norolojik muayenesinde solda Lasegue delili 45 depozitifti, sol Sldermatomunda hipoestezi, palpas-yonla L5, SI uzerinde ve solda Walleix noktalanndahassasiyet tespit edildi. Motor zaaf, refleks ve sfinkterkontrol kusuru yoktu.

Laboratuvar Tetkikleri: Kan biyokimyaslnormal slmrlardaydl, bazal kortizol duzeyi (sabahsaat 8.00 - 8.30) 8 ng/ml, 9.5 ng/ml (normal deger-ler 7-25 ng/ml) olarak saptandl. Direkt grafilerindeL5 duzeyinde interpedinkuler mesafe 29 mm , on-arka ;:ap 15 mm olarak bulundu. Spinal BT' sindeL5-S1 duzeyinde dural kesenin on klsmmda her iki

Tii1* N

Tiirk NOFO$irihji Dergi

Turk Ni5ro~iru1jiDelgisi 5: 82 - 85, 1995

of iatrojenic Cushing's syndrome. Neurology 39 : 1031-1034,1989

5. Maehara T, Tanohata K, Noda M, Nakayama D. : MedicallylJ"eated steroid-induced epidural lipomatozis. Neuroradiol-ogy30 : 281, 1988

6. Marks SM, Miles JB, 5haw MDM : Idiopatic Spinal ExtraduralLipomas: Ihree Cases and Review of the Literature. SUlgNeurol23 : 153-15'>, 1985

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8. MilAvaler Cj, Jacobson I, Howard GC : Idioparjc epidurallipomatosi~ as a cause of pain and neurological symptoms at-tributed inirja/ly to radiation damage. Clin.() ncol-R.c 011-Radiol4 (5) :333-334, 1992 (Abstract)

9. NoelP, Pepersack T, VanbinstA, AIleJL: Spinal epidurallipomatosis in Cushing's syndrome secolldaJY to an adrenaltumOl: Neurology 42: l2!JJ-1251, 1992

Atabey: idyopaljk Spinal Epidural Lipomatozis

10. Per/ing LH, LaurentJP, Cheek WR : Epidural hibemoma asa complication of corticosteroid u'eaImenI. Case reporr. JNeurosUlg69 :6l3-fJ16, 1988

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12. StamboughJL, CheeksML, KeiperGL: Non-glucocorucoid-induced lumbar epidural lipomatozis: a case reporl and re-view of literature.J Spinal Di~ 2: 201-207,1989

13. Tsuzaka K, Takada T, Moriwaka F, Tashiro K, Akino M : A

case of epidural lipomalozis presenting spinal ataxia. Ivil-sho-Shinkeig'dku 31(2) : 206-209, 1991 (Abslract)

14. ZampeJ/a lIT, DuvaJ/ ER, Sekar C, LangfOId KH, Epsrein AE,Kilkling JK, Moraverz RB : Symptomatic spinal epidurallipomatozis as a complication of steroid immunosuppressionin caldiac uanspla11lparjents. J NeurosUlg 67 : 760-764, 19f!7