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EXCESSIVE IRRITABILITY OF AN INFANT: AN UNUSUAL PRESENTATION OF LIPOMA OF THE SPINAL CORD

Alice Chan-Yip, Jean-Pierre Farmer, Patricia Forbes, Augustin O’Gorman

McGill University Health Center (MUHC), Montreal, PQ, Canada

A female infant of Cambodian origin presented at age one month with excessive crying that necessitated hospitalization. The mother was preoccupied with the infant’s intolerance to different milk formula and her belief in Ying-Yang (cold-heat) food imbalance. She was discharged on protein hydrolysate formula with the tentative diagnosis of cow’s milk allergy. Her intensified crying spells at age two & half months led to consultation at the Pediatric Dept. of MUHC. Examination revealed an infant with normal growth parameters. While lying quietly in frog-leg position, she moved her left leg less than the right, began crying when she was moved and diaper was changed. Prolonged ankle clonus was noted more consistently in the left. A dimple was present in mid sacral area with a 1 cm. Lesion of dystrophic skin and underlying mass palpable just to the left of midline. Tenderness was elicited over lower spine. Occult spinal dysraphism was suspected.

Ultrasound examinations of the abdomen and brain were normal. CT scan of spine demonstrated a lobular lipoma (L1-L5) occupying the entire transverse dimension of the spinal canal. MRI illustrated a large lipoma at L1-L5, with cord tethering and fat extension into left-sided neural foramina at L3 and L4. There was a small syrinx at D12 level. Urodynamic studies suggested urinary retention and a neurogenic bladder.

Surgical removal of the lipoma was carried out with prompt resolution of irritability. Mild upper motor neuron deficit remained in the left lower limb in the immediate post-operative period. The implication of early diagnosis of spinal dysraphism, long term follow up and neurological sequalae will be discussed.