Incidental detection of intra-cranial lipoma in patient with quadriparesis

Magnetic Resonance Imaging (MRI) of brain is a non-invasive investigation which is performed frequently now-a-days in clinical neurological practice. Many incidental findings may be seen on MRI brain scans, which may be of little clinical significance. Knowledge on these entities is important, for a clinician to limit unnecessary further evaluations. Here is a description of a case of an incidentally detected, posterior peri-callosal, intracranial lipoma (a rare entity) which had occurred in a patient with quadriparesis, followed by a brief discussion on the types of intracranial lipomas and their clinical significances. A 65-year-old male presented with weakness of both upper limbs and lower limbs of 6-months duration. On examination, his tone was found to be spastic, his deep tendon reflexes were exaggerated and he had bilateral plantar extensor. A provisional diagnosis of spastic quadriparesis was made. Magnetic Resonance Imaging of cervical spine revealed spondylosis with cord compression at the level of C4-C6 vertebral level, which explained the cause of quadriparesis. Interestingly, MRI of his brain revealed a homogenously hyperintense lesion which was noted in T1 weighted images (A), at posterior part of corpus callosum, around the splenium. The lesion was hypointense in T2 (B) images and hyper intense in FLAIR (C) images, which was suggestive of a peri-callosal curvilinear lipoma. Patient was referred to neurosurgery department and he got operated for cervical spondylosis, with significant clinical improvement after surgery.