Cauda Equina Syndrome Caused by Pseudogout Involving the Lumbar Intervertebral Disc

Lee, Jungjun; Cho, Keun-Tae; Kim, Eo-Jin

doi:10.3346/jkms.2012.27.12.1591

Cited by 5 publications

(22 citation statements)

References 12 publications

(36 reference statements)

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“…Pseudogout can deposit in the intervertebral disc, joint capsule, facet cysts, synovial cysts, and spaces within the neural foramen, causing compressive pathological presentations. [2][3][4][5][6][7] It has often been confused radiographically with calcified herniated disc, osteomyelitis/discitis with epidural phlegmon, or an extradural tumor. 5,6 Patients can also present with elevated inflammatory markers, further complicating the initial presentation differential diagnosis and perhaps placing bias on an infectious etiology, a much more common diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Pseudogout, an unconventional imitator of the lumbosacral spine with associated chronic epidural hematoma: illustrative cases

Jaffee

Jeong

Dabecco

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Pseudogout, or calcium pyrophosphate dihydrate (CPPD) disease, is an inflammatory joint disease that most commonly involves the joints of the knees, ankles, and wrists. Pseudogout has also been known to involve the spine, especially the atlanto-occipital joint of the cervical spine, but there is limited documentation of its involvement in the lumbar spine. Though the atypical presentation of spinal pseudogout with findings consistent with discitis and epidural abscess has been documented, its presentation with associated chronic spinal epidural hematoma is a rare entity. OBSERVATIONS The authors present two separate cases of pseudogout involvement of the lumbar spine, one case presenting with a clinical and radiographic picture consistent with discitis and epidural abscess and the other with radiographic and operative findings consistent with a chronic epidural hematoma. LESSONS This case series demonstrates rare and atypical presentations of pseudogout within the lumbosacral spine.

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Section: Discussionmentioning

confidence: 99%

Pseudogout, an unconventional imitator of the lumbosacral spine with associated chronic epidural hematoma: illustrative cases

Jaffee

Jeong

Dabecco

et al. 2022

Journal of Neurosurgery: Case Lessons

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“…In a search of clinical articles, based on PubMed, since the year 2000, only a few case reports [ 5 , 7 , 8 , 10 , 12 , 13 ] of CPPD crystal deposition involving the lumbar spine were found. Specifically, only 2 case reports described acute CPPD crystal arthritis of the lumbar spine ( Table 1 ) [ 8 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…CPPD deposition disease commonly involves the major peripheral joints. Although CPPD deposition disease of the spine is less common, it can involve the ligamentum flavum; the longitudinal, supraspinous, and interspinous ligaments; the intervertebral discs; and the sacroiliac and apophyseal joint [2][3][4][5][6][7][8][9][10][11][12][13][14]. The definitive diagnosis of CPPD deposition disease is suspected on the basis of the clinical picture and radiographic/laboratory findings.…”

Section: Introductionmentioning

confidence: 99%

Acute Attack of Pseudogout with the Wide Lesion in Lumbar Spondylolytic Spondylolisthesis

Kaneyama

Morishita

Kawano

et al. 2020

Case Reports in Orthopedics

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Objective. To report a rare case of an acute attack of calcium pyrophosphate dihydrate (CPPD) deposition disease in a patient with lumbar spondylolytic spondylolisthesis, which demonstrated widespread lesion with neurological deficit. Methods. An 86-year-old woman presented with high fever and bilateral neurological deficit of the lower extremities. Results. CRP was elevated (20.9 mg/dl). Plain radiographs and computed tomography images showed bilateral L4 spondylolytic spondylolisthesis. Sagittal magnetic resonance (MR) images revealed effusion at the L3-4 interspinous space, and a gadolinium- (GD-) enhanced epidural mass was observed at the level of L4 vertebral body. Axial MR images showed an intra- or epidural lesion at L2-3. Moreover, epidural GD-enhanced masses compressed the dural sac in the shape of a cross at the L3-4 and L4-5 segments. The patient was suspected of having pyogenic arthritis of the lumbar spine in initial diagnosis. A total of 1.2 ml of fluid with a murky, pus-like synovial effusion was aspirated from the L3-4 interspinous space under the fluoroscopic image. Smear speculum of synovial fluid tested negative for bacteria and fungi; however, a number of crystals were seen. Based on the result of smear speculum, we suspected the pathology as crystal deposition disease. Based on polarized light microscopy, which revealed monocle or triclinic intracellular crystals with a positive birefringence, the patient was diagnosed with pseudogout of the lumbar spine. Nonsteroidal anti-inflammatory drugs (NSAIDs) were administered by intravenous drip injection for 3 days, and local and systemic inflammatory signs, as well as neurological deficits, dramatically improved. Conclusions. We encountered the rare case of an acute attack of pseudogout with the wide lesion in the lumbar spondylolytic spondylolisthesis. Multiple culture of the effusion provided a definitive diagnosis, which allowed for appropriate, minimally invasive treatment for 8 weeks of NSAID administration that provided the satisfactory recovery from the symptoms.

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“…Although rare, pseudogout can affect the spine; one autopsy study of more than 1,000 spinal specimens from patients with CPPD arthritis showed that crystals can accumulate in a variety of locations in the vertebral column, including the intervertebral disks, median atlantoaxial articulations, intraspinal and extraspinal ligaments, and apophyseal and sacroiliac joints . Pseudogout has also been known to present with mass‐like involvement of the spine that can be mistaken for tumors and has been reported as a cause of cauda equina syndrome . However, crystal‐induced arthritis after arthroplasty is rare, with only several dozen cases reported.…”

Section: Differential Diagnosismentioning

confidence: 99%

An 80‐Year‐Old Man With Fevers, Altered Mental Status, and Joint Effusions

Serling‐Boyd

Wallace

Jarolimova

et al. 2020

Arthritis Care & Research

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Cauda Equina Syndrome Caused by Pseudogout Involving the Lumbar Intervertebral Disc

Cited by 5 publications

References 12 publications

Pseudogout, an unconventional imitator of the lumbosacral spine with associated chronic epidural hematoma: illustrative cases

Pseudogout, an unconventional imitator of the lumbosacral spine with associated chronic epidural hematoma: illustrative cases

Acute Attack of Pseudogout with the Wide Lesion in Lumbar Spondylolytic Spondylolisthesis

An 80‐Year‐Old Man With Fevers, Altered Mental Status, and Joint Effusions

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