Abstract Details

Title Intraventricular lipids: A clue to early diagnosis of asymptomatic spinal dural teratoma rupture

Topic Neuro-oncology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-010

Objective

To describe a unique case where incidental intraventricular lipid droplets lead to early diagnosis of spinal dural teratoma.

Background

Rupture of spinal mature cystic teratomas leading to intracranial lipid dissemination involving subarachnoid and intraventricular spaces has been reported only few times in literature with a theoretical hypothesis of retrograde flow of lipids through foramen of Lushka and Magendie. Lipids in CSF spaces can cause recurrent aseptic lymphocytic meningitis and occasional hydrocephalus.

Design/Methods Case report

Results 64-year-old man with prior history of bladder cancer (in remission) presented after vasovagal syncope resulting in a fall. Neurological exam was normal and CT Head performed due to the fall showed non-dependent hypo-densities in bilateral lateral ventricles that were suggestive of fat (more than air) based on the Hounsfield units. MRI confirmed both intraventricular and disseminated subarachnoid T1 hyper-intensities suggestive of fat droplets prompting MRI of the spinal axis which revealed an intra-dural extra-medullary heterogeneous mass at L1-2 with mild mass effect on the spinal cord with resultant syrinx distal to the level. His fall was presumed to have caused traumatic rupture of cystic teratoma. Surgical resection was deferred initially since patient was asymptomatic but was undertaken 6 months later due to subjective lower extremity numbness, increase in size of mass and prior history of bladder cancer. Pathology showed mature cystic teratoma with adipose tissue, bone and squamous epithelial tissue. Clinical exam and radiographic lipid dissemination pattern remained stable post-operatively with no recurrence at the end of 2 years.

Conclusions

Our case highlights a unique scenario where a syncope related fall led to traumatic, yet asymptomatic, rupture of spinal dural teratoma causing intracranial lipid dissemination; which in turn led to early identification of the spinal teratoma itself and eventual timely resection. Intracranial lipids, even if incidental, should warrant a comprehensive work-up for potential underlying etiologies.

Authors/Disclosures
Aparna Vaddiparti, MD (UAB Medicine, Department of Neurology, Division of Epilepsy) PRESENTER	Dr. Vaddiparti has nothing to disclose.
Annie S. Daniel, MBBS (Department of Neurology , Hospital for Special Care , New Britain , Ct)	Dr. Daniel has nothing to disclose.

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