Y Ding1, W Wang2, W Jiang3, L Zhang4, T Wang5, Z Li2. 1. Department of neurology, Xuanwu Hospital, Capital Medical University, 100053 Beijing, Republic of China. Electronic address: dingyandoctor@126.com. 2. Department of pathology, Xuanwu Hospital, Capital Medical University, 100053 Beijing, Republic of China. 3. Department of anatomy, histology and developmental biology, School of Basic Medical Sciences, Shenzhen University Health Science Centre, 518060 Shenzhen, Republic of China. 4. Department of neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Republic of China. 5. Department of neurology, Xuanwu Hospital, Capital Medical University, 100053 Beijing, Republic of China.
Abstract
OBJECTIVE: To improve neurologists' awareness of spine gout by showing a rare case of tophaceous gout in thoracic spine and a summary of vertebral gout in order. MATERIAL AND METHODS: We reported a case of a 36-year-old male with a 2-year-history of hyperuricemia. Neurological examination suggested that the strength of his lower limbs decreased. Bilateral Babinski's sign and ankle clonus were positive. He had no bladder or bowel dysfunction. Computed tomography of the thoracic spine showed occupied lesions at the T9, T10 levels which led to the spinal stenosis. Magnetic resonance imaging of the thoracic spine revealed epidural disease at T9, T10 levels. A resection of the occupying lesion in the thoracic spinal canal was performed, tophaceous gout was diagnosed by the pathological examination. We also provide a brief review of literature on 30 cases of spine tophaceous gout. RESULT: Spinal tophaceous gout is rare, gout can involved in any spine level, but the probability of occurrence of thoracic spine is the least. Most patients had a history of hyperuricemia or peripheral tophus, the most common symptoms are back pain, when the pain stone compression spinal cord or nerve root, there will be the corresponding neurological symptoms or signs. CONCLUSIONS: The spinal gout should be considered when a patient has chronic or acute back pain and/or neurological symptoms, with mass on sides of the vertebras on MRI, especially when the patient has a history of hyperuricemia, the pathology examination can confirm the diagnosis.
OBJECTIVE: To improve neurologists' awareness of spine gout by showing a rare case of tophaceous gout in thoracic spine and a summary of vertebral gout in order. MATERIAL AND METHODS: We reported a case of a 36-year-old male with a 2-year-history of hyperuricemia. Neurological examination suggested that the strength of his lower limbs decreased. Bilateral Babinski's sign and ankle clonus were positive. He had no bladder or bowel dysfunction. Computed tomography of the thoracic spine showed occupied lesions at the T9, T10 levels which led to the spinal stenosis. Magnetic resonance imaging of the thoracic spine revealed epidural disease at T9, T10 levels. A resection of the occupying lesion in the thoracic spinal canal was performed, tophaceous gout was diagnosed by the pathological examination. We also provide a brief review of literature on 30 cases of spine tophaceous gout. RESULT: Spinal tophaceous gout is rare, gout can involved in any spine level, but the probability of occurrence of thoracic spine is the least. Most patients had a history of hyperuricemia or peripheral tophus, the most common symptoms are back pain, when the pain stone compression spinal cord or nerve root, there will be the corresponding neurological symptoms or signs. CONCLUSIONS: The spinal gout should be considered when a patient has chronic or acute back pain and/or neurological symptoms, with mass on sides of the vertebras on MRI, especially when the patient has a history of hyperuricemia, the pathology examination can confirm the diagnosis.
Authors: Duniel Abreu Casas; Orestes R López-Piloto; Norbery J Rodríguez de la Paz; José M Plasencia-Leonardo; Daniel Íñiguez-Avendaño; Joel V Gutierrez Journal: Cureus Date: 2022-07-21