2026 American Academy of Neurology Abstract Website

Objective:

Spinal-Epidural-Lipomatosis(SEL) is treatable condition whose proper recognition is critically important. Misdiagnosis, particularly as neuro-inflammatory-disease, can lead to steroid misuse, which may exacerbate lipomatosis and worsen neurological outcomes. Increasing its awareness is necessary among neurologists.

Background:

Defined by abnormal accumulation of unencapsulated mature fat in spine epidural space, SEL is well-established cause of neurological symptoms. While generally described as "rare," our recent encounter with two radiologically missed cases in a single month strongly suggests its true prevalence is significantly underestimated.

Design/Methods:

In this case report, both patients shared key risk factors: high BMI and history of steroid use. Their CSF MS/NMOSD/MOGAD/Biofire/Autoimmune panel negative.

Case 1: Thoracic SEL—Neuro-Inflammatory Mimic. 31-year-old male(BMI 49) presented with progressive left lower extremity weakness. His complex history included prior transient visual loss (orbital-MRI negative for optic neuritis) and right leg weakness that resolved following L4–L5 laminectomy. Multiple prior head, cervical, and lumbar MRIs had been unremarkable. A new thoracic MRI showed spinal cord T2 hyperintensity, raising strong concern for neuro-inflammation. Patient was empirically treated with steroids, which did not improve symptoms. Retrospective review of thoracic MRI ultimately confirmed diagnosis of SEL

Results:

Case 2: Lumbar SEL—Spine Degeneration Mimic. A 53-year-old female(BMI 35.8) presented with intermittent lower extremity paraparesis, neurogenic claudication, and culminating saddle anesthesia, concerning suspected Cauda Equina Syndrome. Neuro Exam was normal. Initial MRI review focused on T9–T10 disc herniation but deemed unlikely to cause her symptoms. Retrospective review of Lumbar MRI subsequently revealed SEL: Characteristic "Y-shape" sign is being formed.

Conclusions:

Given increasing prevalence of obesity and widespread steroid use, SEL is likely far from rare. Neurologists must heighten their suspicion index, especially in patients with these risk factors whose neurological symptoms do not align with typical neuro-inflammatory or spine degenerative diseases. Increased awareness facilitates earlier diagnosis and intervention, preventing unnecessary steroid exposure and avoiding neurological decline.