Late diagnosis of dorsolumbar lipomyelomeningocele with tethered cord in a middle aged adult: A case report from Nepal.

Closed spinal dysraphism can present with diagnostic issues in settings with limited resources, when knowledge of the disorder and specialized radiological studies, such as magnetic resonance imaging (MRI), may not be readily available. Undiagnosed cases can develop serious neurological deficits. Here, we describe a case of dorsolumbar lipomyelomeningocele, a type of closed spinal dysraphism, presenting in a middle aged with paraplegia complicated by bed sores. A 38-year-old female with no significant past medical history experienced gradually progressive weakness of bilateral lower limbs over 9 years. On physical examination, patient had a soft swelling with hairy tuft over the lumbar spine, paraplegia, grade III bed sore over the gluteal region, and sensory loss below L1 sensory level. Her bowel and bladder sensation were decreased. The soft tissue swelling over her back was not evaluated appropriately before this presentation. MRI of the spine revealed dorsolumbar lipomyelomeningocele with tethered spinal cord.