title: [Thoracic spinal cord compression by a gouty tophus. Case report. Review of the literature].
abstract: 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.
authors.affiliation: Service de Neurochirurgie B, Hôpital Neurologique et Neurochirurgical, 59, boulevard Pinel, BP Lyon Montchat, 69394 Lyon Cedex 03, France.
authors.forename: P
authors.initials: P
authors.lastname: Bret
authors.forename: A C
authors.initials: AC
authors.lastname: Ricci
authors.forename: G
authors.initials: G
authors.lastname: Saint-Pierre
authors.forename: C
authors.initials: C
authors.lastname: Mottolese
authors.forename: J
authors.initials: J
authors.lastname: Guyotat
mesh_terms: 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