[Thoracic spinal cord compression by a gouty tophus. Case report. Review of the literature].
An unusual case of thoracic spinal cord compression caused by extradural tophaceous deposits is reported in a 59-year-old female with a long-standing history of gout involving the metatarsophalangeal joints. T1 and T2 magnetic resonance images of the spine illustrated an extradural hyperintense signal extending from T2 to T9. A decompressive laminectomy disclosed a white caseum-like material in the extradural space, together with a small organized hematoma. Histologic examination showed areas of amorphous substance containing urate crystals surrounded by inflammatory cells, which was diagnosed as a gouty tophus. The patient made an uneventful recovery after surgery. Fifteen similar cases of the literature are reviewed. Although spinal involvement by gout seems relatively common, a compression of the spinal cord or of the cauda equina in gout patients seems exceptional. The diagnosis should be considered in patients showing a relevant history of gout, but spinal cord compromise may also represent the initial manifestation of the disease.
Bret
P
P
Service de Neurochirurgie B, Hôpital Neurologique et Neurochirurgical, 59, boulevard Pinel, BP Lyon Montchat, 69394 Lyon Cedex 03, France.
Ricci
A C
AC
Saint-Pierre
G
G
Mottolese
C
C
Guyotat
J
J
D015210:Arthritis, Gouty / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008683:Metatarsophalangeal Joint; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000209:etiology* / Q000601:surgery; D013122:Spinal Diseases / Q000150:complications* / Q000175:diagnosis; D013904:Thoracic Vertebrae