A rare cause of spinal cord compression: imaging appearances of gout of the cervical spine

Dharmadhikari, Rahul; Dildey, Petra; Hide, I.G.

doi:10.1007/s00256-006-0088-2

Cited by 21 publications

(15 citation statements)

References 8 publications

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“…A history of peripheral gout for several months or years preceding the neurological manifestations occurs in the large majority of patients and helps in the clinical diagnosis [ 6 ]. Nevertheless, it is worth pointing out that, in the literature, there are reports of gout with axial involvement with nerve compression without a previous history of peripheral arthritis [ 7 ]. The concomitant presence of “spinal gout” and the peripheral joint involvement with a rheumatoid-like pattern as seen in our patient is unique.…”

Section: Discussionmentioning

confidence: 99%

“…CT can show facet joint erosions that are more consistent with gout than with degenerative alterations [ 11 ]. MRI can be very useful in a differential diagnosis since the tophi present a low signal in the pondered sequence in T1 and a low or high heterogeneous signal in the pondered images in T2 (the high signal is owing to the filling of the amorphous center of the tophus with high protein content [ 7 ] and the heterogeneity and to the varied levels of calcium deposits in the tophus [ 12 ]) and present variable peripheral enhancement after gadolinium administration.…”

Section: Discussionmentioning

confidence: 99%

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Gout Initially Mimicking Rheumatoid Arthritis and Later Cervical Spine Involvement

Nunes

Rosseti

Ribeiro

et al. 2014

Case Reports in Rheumatology

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Gout is clinically characterized by episodes of monoarthritis, but if not treated properly, it can lead to a chronic polyarthritis, which may eventually mimic rheumatoid arthritis (RA). We present the case of a 59-year-old man, with a history of symmetrical polyarthritis of the large and small joints with later development of subcutaneous nodules, which was initially misdiagnosed as RA, being treated with prednisone and methotrexate for a long period of time. He complained of occipital pain and paresthesia in his left upper limb, and computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of an expansive formation in the cervical spine with compression of the medulla. He was admitted for spinal decompressive surgery and the biopsy specimen demonstrated a gouty tophus. Chronic gout can mimic RA and rarely involves the axial skeleton, and thus its correct diagnosis and the implementation of adequate therapy can halt the development of such damaging complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gout Initially Mimicking Rheumatoid Arthritis and Later Cervical Spine Involvement

Nunes

Rosseti

Ribeiro

et al. 2014

Case Reports in Rheumatology

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“…On MRI, appendicular gout typically shows intermediate to low signal intensity on T1-and T2-weighted with variable heterogeneous enhancement 2 . Diagnostic adjuncts include fluorodeoxyglucose-positron-emission tomography (FDG-PET), where lesions are hypermetabolic 3 .…”

Section: Le Journal Canadien Des Sciences Neurologiquesmentioning

confidence: 99%

Gouty Arthropathy of the Axial Skeleton Causing Cord Compression and Myelopathy

Ibrahim

Ebinu

Rubin

et al. 2011

Can. J. Neurol. Sci.

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Can. J. Neurol. Sci. 2011; 38: 918-920 A 70-year-old Caucasian female with a past medical history of hypertension, chronic renal insufficiency, dyslipidemia, hypothyoidism, anemia, congestive heart failure, recent humeral fracture, and longstanding gout, presented with a one-year history of progressive weakness and falls, increasing "clumsiness" in her hands and weakness of the lower extremities. Bowel and bladder function were intact.On examination, resistance in the lower extremities was reduced, sensation was diminished bilaterally, and hyperreflexia with sustained ankle clonus noted.Computed tomogram (CT) and magnetic resonance imaging (MRI) of the spine (Figures 1 and 2) revealed a bilateral destructive process involving the posterior elements of T1 and T2, centered on the facet joints. There was anterior listhesis of T1 on T2 and increased T2 signal within the spinal cord. She underwent posterior decompression with instrumented fusion. Surgical pathology of the spinal mass was sent for histology and crystal analysis (Figure 3). Monosodium urate crystals were detected. The patient's deficits gradually improved postoperatively and the management of her gout (Serum Uric Acid [SUA] at presentation 792 umol/L) was optimized.Gouty arthropathy of the axial skeleton is well-described, affecting up to 17% of patients with chronic gout and is typically localized to the sacroiliac joints and the facet joints of spinal https://www.cambridge.org/core/terms. https://doi

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“…5,6 Gout could involve all the segments of the spine but it appears to be more common in the lumbar spine (44-54%). 7,8 Deposits of tophaceous gout could be found in any part of the vertebra, including facet joint, 9 vertebral body, 10 pedicle, 11 lamina, 12 ligamentum flavum, 13 and disc. 14,15 Symptomatic spinal gout can present with features of back pain, spinal stenosis, myelopathy, radiculopathy and cauda equina syndrome.…”

Section: Introductionmentioning

confidence: 99%