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|Year : 2015 | Volume
| Issue : 2 | Page : 284-285
Spinal gout: A rare cause of paraplegia
Divyanshu Dubey1, Emily Steen1, Anshudha Sawhney1, Olaf Stuve2
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 Publication||5-May-2015|
Dr. Divyanshu Dubey
University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas
Source of Support: None, Conflict of Interest: None
|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
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.  Most commonly, the lesions are located in the lumbar spine.  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%.  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. ,
Surgical intervention is required in many of the symptomatic patients with spinal gout.  Medical management with urate lowering agents such as allopurinol has also been used in some patients. 
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|[Pubmed] | [DOI]|