Papilloedema in association with spinal lipoma and bilateral chronic subdural bleeding.
METHODS
A case report describing a patient presenting with papilloedema, headache and saddle hypoesthesia caused by a lumbo-sacral intraspinal extradural lipoma in the presence of a bilateral chronic subdural haematoma (cSDH).


OBJECTIVE
The aim of this report is to discuss the pathophysiology of papilloedema in spinal tumours and the effect of the cSDH on the development of papilloedema. A search of the Medline database yielded no case reports describing papilloedema arising from spinal extradural lipoma in the presence of intracranial cSDH.


METHODS
Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.


METHODS
We report a clinical case of cauda equina compression due to an extradural lipoma presenting with papilloedema. Cranial computer tomography (CT-scan) additionally revealed a thin, bilateral cSDH. The patient underwent surgical excision of the lipoma subsequent to an L5-S3 laminectomy. On duratomy, a membranous thrombus formation was discovered between the nerve filaments. The patient experienced clinical improvement with regression of his neurological symptoms. Histological findings confirmed the diagnosis of lipoma and intradural thrombus.


CONCLUSIONS
Spinal tumours may cause complex cerebrospinal fluid (CSF) dynamic and resorptive changes. These changes are mechanical, physiological or combined in their effect. Patients with papilloedema or increased intracranial pressure should be carefully examined by clinical and neuro-radiological means for cranial and spinal pathologies. The treatment of the primary cause might save the patient a series of unnecessary procedures.
Al-Zain
F
F
Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany. ferass@al-zain.de
Gräwe
A
A
Meier
U
U
D000328:Adult; D002420:Cauda Equina / Q000473:pathology / Q000601:surgery; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D002908:Chronic Disease; D019299:Decompression, Surgical; D004172:Diplopia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D004388:Dura Mater / Q000473:pathology / Q000503:physiopathology; D004824:Epidural Space / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D007839:Functional Laterality / Q000502:physiology; D020200:Hematoma, Subdural, Chronic / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D007796:Laminectomy; D008067:Lipoma / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D017116:Low Back Pain / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010211:Papilledema / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D011128:Polyradiculopathy / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D013125:Spinal Neoplasms / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D013355:Subdural Space / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome