SHM Converge Scientific Abstract ePoster Gallery-From Jaw Pain to Spinal Strain: A Rare Case of Epidural Angiolipoma

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This case report describes a 56-year-old man who presented with fever, jaw pain, and rapidly progressive weakness that began in the lower extremities and ascended to the upper extremities. He was initially treated for a presumed dental abscess with fluids, Zosyn, and dexamethasone, but his worsening neurologic deficits and loss of reflexes raised concern for spinal cord pathology rather than infection alone.<br /><br />MRI of the thoracic spine revealed a T3–T6 enhancing dorsal epidural lesion causing severe spinal cord compression and surrounding edema. Because the presentation mimicked an epidural abscess or other inflammatory neurologic condition, he was transferred to a tertiary center for urgent neurosurgical evaluation. He underwent emergent T4–T6 laminectomy with complete removal of the lesion.<br /><br />Histopathology confirmed a spinal epidural angiolipoma, a rare benign tumor composed of mature fat and abnormal vascular channels. SEAs are uncommon, accounting for a very small fraction of spinal and epidural tumors, and usually present with slowly progressive back pain or weakness. Acute paralysis is rare and may occur due to hemorrhage, thrombosis, or other triggers.<br /><br />The authors propose that systemic inflammation from the suspected dental infection may have increased vascular congestion and edema within a previously silent angiolipoma, precipitating sudden cord compression. This unusual presentation highlights the diagnostic challenge of acute myelopathy, which can resemble Guillain-Barré syndrome, epidural abscess, or other spinal emergencies.<br /><br />The key takeaways are to maintain a broad differential diagnosis for acute weakness, use MRI early when spinal pathology is suspected, and pursue rapid surgical decompression when cord compression is present. Early intervention and histologic confirmation are critical to preventing permanent neurologic injury.

Asset Subtitle

Angelina Piryani

Meta Tag

Author List Aliaa Hassanin, Angelina Piryani, Anish Kumar, Manisha Piryani

Category Clinical Vignettes

Concept Spinal Epidural Angiolipoma

Concept Spinal Cord Compression

Concept Neurologic Findings

Concept Decompression

Concept Histopathology

Distinguished Non-Finalist

Presenter Organization Ross University School of Medicine

Presenting Author Angelina Piryani

Track Adult

Keywords

spinal epidural angiolipoma

acute myelopathy

thoracic spinal cord compression

epidural lesion

laminectomy

rapidly progressive weakness

MRI spine

neurologic deficits

epidural abscess differential

surgical decompression

Spinal Epidural Angiolipoma

Spinal Cord Compression

Neurologic Findings

Decompression

Histopathology