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Spinal dysraphism in an elderly patient
M Manfredi1, E Donati, E Magni
1Department of Neurology, Casa di Cura Poliambulanza, Brescia, Italy.
Insights
Spinal malformations like lipomyeloschisis can occur in elderly patients, causing myelopathy. Advanced neuroimaging accurately diagnoses these rare late-onset spinal conditions and reveals critical structural details.
Area of Science:
- Neurology
- Radiology
- Developmental Biology
Background:
- Spinal dysraphisms are congenital conditions typically diagnosed in infancy.
- Late-onset presentations of spinal dysraphisms are uncommon but can lead to significant neurological deficits.
Observation:
- An elderly patient presented with symptoms and signs suggestive of myelopathy.
- Neuroimaging revealed an intraspinal mass consistent with lipomyeloschisis, a type of spinal dysraphism.
- The mass was continuous with a subcutaneous lipoma, and a dermal sinus was also identified.
Findings:
- Magnetic resonance imaging (MRI) delineated the intraspinal lipoma and its connection to the subcutaneous tissue.
- Three-dimensional computed tomography (3D CT) reconstructions provided detailed visualization of the spinal dysraphism and associated dermal sinus.
- The findings confirmed a rare, late-onset presentation of spinal dysraphism.
Implications:
- Neuroimaging is crucial for diagnosing spinal dysraphisms in elderly patients presenting with myelopathy.
- Detailed structural information from MRI and 3D CT aids in precise diagnosis and understanding of complex spinal malformations.
- This case highlights the importance of considering congenital spinal anomalies even in advanced age when myelopathic symptoms arise.
Abstract:
Spinal dysraphisms are diagnosed more frequently at birth or in infancy. We report a spinal malformation compatible with lipomyeloschisis in an elderly patient presenting with symptoms and signs of myelopathy. Magnetic resonance imaging revealed an intraspinal mass continuous with a subcutaneous lipoma. Three-dimensional computed tomography reconstructions better showed the spinal dysraphism; dermal sinus was also evident. Neuroimaging can define the precise diagnosis also in elderly patients presenting with myelopathy and can provide valuable structural details.