Case Report Headaches and Finding of Lipoma Intraduralis Intramedularis Regio C1/C4

Introduction: Headaches in children are very common symptom. About 75% of children had a headache at least once a year, while 30% have recurrent headaches. They can be primary, inorganic and secondary, organic. The secondary may be caused by brain trauma, vascular disease and brain tumors. Brain tumors are the second most frequent in children after leukemia. The incidence is 4 per 100 000 children. Good history and early diagnosis are the most important for the outcome of the disease.

Case: A girl aged 9 coming to the examination because of a knock to the head. There were no signs of brain contusion. Even before the knock, the girl was complaining of periodical headaches treated by ibuprofen. She was born with mild hypotonia (CNS Ultra Saund and EEG examinations were normal), due to which the physical treatment was performed during the first 5 years of life. Myopia was diagnosed at age of seven. Neurological examination didn’t reveal pathological deficiencies. MRI shows expansive intradural lesion (52x27x19 mm) of craniocaudal extension from the Framen Ovale Magnum up to the level C4, in the dorsal part of the spinal canal. The mutation compresses the medulla but without the signs of myelomalacia and cerebrospinal fluid flow obstruction. The girl has been operated and the PH findings showed that it was an intramedullary lipoma,a very rare primary benign tumor. Follow-up MRI of endocranium and cervical spine showed present remains of lipoma (45x21x15 mm) with milder degree of medulla compression.

Conclusion: Intradural intramedullary tumors represent 35% of all spinal tumors in childhood period. Intradural lipomas are even rarer and constitute only 1% of spinal cord tumours. Monitoring of headaches in the childhood period is necessary.MRI diagnostics is reasonable even when there are no neurological disorders and symptomatic seizures. Proper anamnesis is a base for further diagnostics.