Teaching NeuroImages: Severe myelopathy due to epidural lipomatosis

Teaching NeuroImages: Acute neurologic deficits due to surfer's myelopathy.

A previously healthy 32-year-old man developed acute onset of lower extremity weakness (American Spinal Injury Association [ASIA]–motor L2-S1, grade 2/5), T8 sensory level, and loss of bowel and bladder control (ASIA Impairment Scale [AIS] C) while surfing. The patient was a novice surfer and recalled a prolonged period in prone hyperextension. MRI spine was consistent with surfer’s myelopathy,...

Teaching neuroimages: "pancake-like" gadolinium enhancement suggests compressive myelopathy due to spondylosis.

A 41-year-old man developed progressive bilateral hand weakness and spastic paraparesis. MRI demonstrated cord edema and “pancake-like” gadolinium enhancement (figure). Inflammatory/neoplastic causes were investigated and not found. He continued to deteriorate despite empiric corticosteroid treatment. One year later, cervical decompression stabilized his clinical condition but intramedullary T2...

Thoracic myelopathy from coincident fluorosis and epidural lipomatosis.

Skeletal fluorosis is rare in NorthAmerica. It can present with back pain and extremity weakness. Immobilization of the spine and the extremity joints can occur. It is usually caused by abnormally increased oral fluoride intake over many years. Epidural lipomatosis is usually caused by idiopathic obesity or corticosteroid use. It has been linked to highly active antiretroviral therapy (HAART) f...

Teaching NeuroImages: Posttraumatic lumbar epidural hematoma.

Teaching NeuroImages: multiple epidural abscesses after acupuncture.

An 80-year-old woman presented with 2 days of progressive quadriparesis, difficulty voiding, and fever. She had received acupuncture in the cervical and lumbar regions for 5 days beginning a week before. Whole-spine MRI showedmultiple epidural abscesses at levels C3-C7, L3-L5, and L5-S1 (figure). Broad-spectrum antibiotics were administered, and the abscesses were surgically drained. Strains of...