Central and peripheral neuropathy as the manifestations of multiple symmetric lipomatosis: one case report and review of literatures

Objective To summarize the clinical manifestations and imaging features of multiple symmetric lipomatosis (MSL) combined with central and peripheral neuropathy, and to explore its pathogenesis. Methods and Results We reported a 66-year-old man with long-term history of alcoholism. Several large symmetric and painless lipomas were found in his bilateral lower jaw, shoulders, neck and upper back over the past 2 years. The patient suffered from numbness and weakness of both lower extremities for 6 months, and sudden dullness, balderdash, even painless ulcer in the right sole for 15 d. Neurologic examination showed that his recent memory, calculation and understanding ability were decreased, and it appeared bilateral pyramidal tract syndrome and ataxia. The algesia and thermesthesia below the right knee were lost, and topesthesia and pallesthesia were decreased. Cervical MRI showed cervical subcutaneous symmetric and non-encapsulated fat-intense mass. No significant abnormality was found in brain MRI. It was eventually diagnosed with MSL combined with central and peripheral neuropathy. The treatment included oral mecobalamine, cobamamide, folate, compound diisopropylamine dichloroacetate, rosuvastatin, and abstaining from alcohol. The patient was hospitalized for 14 d and followed up for 3 months, and the symptoms disappeared partially. Conclusions MSL is a rare disease with abnormal fat metabolism, which can result in both central and peripheral neuropathy. The pathogenesis of MSL, especially the cause of brain damage in MSL needs to be further explored.