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Spinal epidural angiolipoma is a rare benign tumor containing vascular and mature adipose elements. A slow progressive clinical course was mostly presented and rarely a fluctuating course during pregnancy. The authors report the original case of spontaneous spinal epidural bleeding resulting from thoracic epidural angiolipoma who presented with hyperacute onset of paraplegia, simulating an extradural hematoma. The patient was admitted with sudden non-traumatic hyperacute paraplegia during a prolonged walk. Neurologic examination showed sensory loss below T6 and bladder disturbances. Spinal MRI revealed a non-enhanced heterogeneous thoracic epidural lesion, extending from T2 to T3. A bilateral T2-T4 laminectomy was performed to achieve resection of a lipomatous tumor containing area of spontaneous hemorrhage. The postoperative course was uneventful with complete neurologic recovery. Histologic examination revealed the tumor as an angiolipoma. Because the prognosis after rapid surgical management of this lesion is favorable, the diagnosis of spinal angiolipoma with bleeding should be considered in the differential diagnosis of hyperacute spinal cord compression.

Ossification of the ligamentum flavum is common in Japan but rare in Western countries. Myelopathy of variable severity is a possible complication. Extension of the lesions over several levels at the thoracic spine is exceedingly rare. We report a new case in a 50-year-old man who had slowly progressive spinal cord compression with a sensory level at the navel. Computed tomography (CT) and magnetic resonance imaging (MRI) of the thoracic spine showed calcium-density masses that were in contact with the neural arches and bulged into the spinal canal at T5/T6, T7/T8, T9/T10, and T10/T11. Laboratory test findings were unremarkable. Surgical decompression by laminectomy and foraminotomy was followed by a favorable outcome. Histology showed extensive areas of bone metaplasia associated with calcific deposits. The diagnosis, treatment, and possible etiologies of this rare condition are discussed based on a literature review.

Background: Extensive spinal epidural hydatidosis may contribute to extensive spinal cord compression. Multilevel laminectomy with surgical excision remains the gold standard for treating these lesions which are typically invasive, and have a high recurrence rate. Case Description: A 35-year-old female with recurrent extensive spinal epidural hydatid cysts was treated with a limited laminectomy and uniquely with irrigation-aspiration with isotonic saline water through an epidural catheter under fluoroscopic guidance and x-ray control. The postoperative MRI documented the hydatid cysts have collapsed and the patient's paraparesis improved. She developed no disease recurrence or renewed deficits over the next 12 months. Conclusion: Through a laminectomy, an epidural catheter may be introduced under fluoroscopic guidance/x-ray control to uniquely irrigate with isotonic saline/aspirate and decompress--the epidural hydatid cysts. This is particularly useful in patients with significant comorbidities, who are not candidates for more aggressive surgical decompression. Further, all patients should be continued on prolonged chemotherapy and should be monitored closely due to the high rate of recurrence of these cysts. [ABSTRACT FROM AUTHOR]

A case of post-traumatic arachnoiditis ossificans of the cauda equina is reported. The lesion is a rare pathological entity usually confined to the thoracic and high lumbar regions that can cause progressive spinal cord and cauda equine compression. The pathophysiology and therapeutic strategy of this rare entity are still controversial. [ABSTRACT FROM AUTHOR]

Ossification of the ligamentum flavum is common in Japan but rare in Western countries. Myelopathy of variable severity is a possible complication. Extension of the lesions over several levels at the thoracic spine is exceedingly rare. We report a new case in a 50-year-old man who had slowly progressive spinal cord compression with a sensory level at the navel. Computed tomography (CT) and magnetic resonance imaging (MRI) of the thoracic spine showed calcium-density masses that were in contact with the neural arches and bulged into the spinal canal at T5/T6, T7/T8, T9/T10, and T10/T11. Laboratory test findings were unremarkable. Surgical decompression by laminectomy and foraminotomy was followed by a favorable outcome. Histology showed extensive areas of osseous metaplasia associated with calcific deposits. The diagnosis, treatment, and possible etiologies of this rare condition are discussed based on a literature review. [ABSTRACT FROM AUTHOR]

Résumé: Le myélome multiple est une hémopathie maligne multifocale qui touche préférentiellement le rachis. Un homme de 47 ans a été hospitalisé pour une paraplégie progressive, accompagnée de troubles sensitifs superficiels et profonds, de niveau D4. L’imagerie par résonance magnétique a mis en évidence une masse épidurale qui comprimait la moelle entre D4 et D6. L’os était intact. Une décompression postérieure de D4 à D6 a été réalisée. L’histologie avec marquage immunohistochimique a mis en évidence un myélome multiple à chaînes kappa. Une immunoglobuline G kappa monoclonale a été mise en évidence par immunoélectrophorèse des protéines sériques. Les tumeurs épidurales extra-osseuses responsables de compression médullaire en l’absence de destruction ou de tassement vertébral sont rares. À notre connaissance, seuls quatre cas ont été décrits dans la littérature médicale anglophone. [Copyright &y& Elsevier]