[A case of lumbosacral lipoma-associated adult onset tethered cord syndrome with initial symptoms of sensory disturbance and intractable foot ulcers].
A 63-year-woman who complained of sensorimotor disturbance of the lower extremities and urinary disturbance was presented. She noted loss of superficial sensation in both feet and foot ulcers at the age of 20 years. Her illness was initially diagnosed as hereditary sensory neuropathy type 1 (HSN1). The foot ulcers were so intractable that she had to have her right leg amputated at the age of 48 years. She had a severely impaired superficial sensation in the lower extremities and buttock, distal weakness of the left leg, and dysuria at the age of 60 years. The neurological examination revealed that she had segmental sensorimotor disturbance below the levels of the 5th lumbar segment. MRI demonstrated tethered cord with a lumbosacral lipoma. Adult onset tethered cord syndrome (TCS) that presents with HSN 1-like symptoms as initial clinical features has not yet been reported. Foot ulcers are often seen in child onset TCS in which the degree of tethered cord is severer than adult onset cases. It is reported that release of the tethered cord promotes healing of the foot ulcers. We recommend MRI for the study of the lumbosacral cord of patients with HSN 1-like symptoms, because there is a possibility that such patients may have TCS and early surgical treatment is effective for TCS.
Okada
K
K
Mishima
Y
Y
Hashimoto
T
T
Tsuji
S
S
Murai
Y
Y
D002607:Charcot-Marie-Tooth Disease; D003937:Diagnosis, Differential; D005260:Female; D016523:Foot Ulcer / Q000209:etiology*; D006801:Humans; D008067:Lipoma / Q000150:complications*; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology*; D016136:Spina Bifida Occulta / Q000150:complications* / Q000175:diagnosis; D013120:Spinal Cord Neoplasms / Q000150:complications*