Lipomeningomyelocele with tethered cord syndrome: an unusual cause of paraparesis in adults.

DESCRIPTION A 28-year-old lady presented with weakness in both lower limbs for 4 months, urinary and fecal incontinence for 3 months along with sensory loss in the perianal region and below both knees for 3 months. Clinical examination revealed intact higher mental functions and normal cranial nerves. A small paramedian swelling, 10×12 cm in size, soft in consistency was noted in lumbosacral region (figure 1). She had hypotonia in both lower limbs with power being Medical Research Council grade 3 in both hips, grade 2 in both knees and ankles. Tone and power were normal in both upper limbs. Both knee and ankle jerks were absent. Planters were non-elicitable. She had loss of sensations in perianal and saddle distribution along with sensory loss below the knees. Thus, she had features of a cauda-conus syndrome. MRI of lumbosacral spine was done which revealed spina bifida with defect in posterior elements of L3, L4, L5 and S1 vertebral bodies and defect in lumbar fascia. The cord was low lying and tethered anteriorly at L2 level. Syrinx was noted in the distal cord (extending below L2 level) proximal to the tethered site. Herniation of fat, meninges and neural elements was seen through the defect in posterior elements of L3–S1 vertebra forming a cystic swelling in the lumbosacral region (figures 2A–D and 3A,B). No evidence of any cerebrospinal fluid herniation was noted. Skin overlying the swelling was intact. No evidence of any herniation of cerebellar tonsils or descent of brainstem was seen. Thus,