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NEUROIMAGE
Year : 2015  |  Volume : 63  |  Issue : 2  |  Page : 284-285

Spinal gout: A rare cause of paraplegia


1 Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
2 Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Neurology, VA North Texas Health Care System, Dallas, Texas, USA

Date of Web Publication5-May-2015

Correspondence Address:
Dr. Divyanshu Dubey
University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.156318

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How to cite this article:
Dubey D, Steen E, Sawhney A, Stuve O. Spinal gout: A rare cause of paraplegia. Neurol India 2015;63:284-5

How to cite this URL:
Dubey D, Steen E, Sawhney A, Stuve O. Spinal gout: A rare cause of paraplegia. Neurol India [serial online] 2015 [cited 2019 Oct 15];63:284-5. Available from: http://www.neurologyindia.com/text.asp?2015/63/2/284/156318


A 39-year-old man with a past medical history of gout presented with severe back pain. He had been wheelchair-bound for the last 6 months. Neurological examination demonstrated lower extremity weakness in a pyramidal pattern (right 4/5; left 4+/5), bilateral knee and ankle hyperreflexia, and a positive Babinski's sign. He had intact pain and temperature but decreased vibration and proprioceptive sensations involving bilateral lower extremities. His thoracic magnetic resonance imaging (MRI) scan showed a significant spinal canal stenosis with myelomalacia [Figure 1]a. His spinal canal decompression was performed by excising the large (4 cm × 2 cm × 1 cm) granular mass attached to the ligamentum flavum that was compressing the spinal cord at the T10-T11 levels. A histopathological examination of the mass indicated the presence of crystalline gout [Figure 1]b. The patient improved substantially with physical therapy and was discharged on allopurinol and tapering doses of prednisolone.
Figure 1: (a) Thoracic spine MRI showing significant stenosis and increased cord signal intensity on sagittal short T1 inversion recovery (STIR) from T10 to T11 vertebral segments (arrow) associated with myelomalacia.(b) Histopathological staining with hematoxylin and eosin of the epidural mass revealed focal crystalline deposits rimmed by histiocytes and giant cells surrounded by fibrous tissue consistent with a diagnosis of gout

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Gout usually involves peripheral joints but has been rarely reported to involve the spine. [1] Most commonly, the lesions are located in the lumbar spine. [2] As many of the patients are asymptomatic, this condition may be under diagnosed. One study reported that the frequency of involvement of the axial skeleton may be as high as 14%. [2] The MRI of spine can assist in the diagnosis as the tophus is iso- or hypointense on T1-weighted images and has a variable signal intensity on T2-weighted images (calcified segments being hypointense). Post-gadolinium T1-weighted images may show areas of peripheral enhancement. [1],[2]

Surgical intervention is required in many of the symptomatic patients with spinal gout. [3] Medical management with urate lowering agents such as allopurinol has also been used in some patients. [4]

 
  References Top

1.
Ahmad I, Tejada JG. Spinal gout: A great mimicker. A case report and literature review. Neuroradiol J 2012;25:621-5.  Back to cited text no. 1
    
2.
Konatalapalli RM, Demarco PJ, Jelinek JS, Murphey M, Gibson M, Jennings B, et al. Gout in the axial skeleton. J Rheumatol 2009;36:609-13.  Back to cited text no. 2
    
3.
Draganescu M, Leventhal LJ. Spinal gout: Case report and review of the literature. J Clin Rheumatol 2004;10:74-9.  Back to cited text no. 3
    
4.
Dhote R, Roux FX, Bachmeyer C, Tudoret L, Daumas-Duport C, Christoforov B. Extradural spinal tophaceous gout: Evolution with medical treatment. Clin Exp Rheumatol 1997;15:421-3.  Back to cited text no. 4
    


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This article has been cited by
1 Gout in the Spine: Imaging, Diagnosis, and Outcomes
Michael Toprover,Svetlana Krasnokutsky,Michael H. Pillinger
Current Rheumatology Reports. 2015; 17(12)
[Pubmed] | [DOI]



 

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