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Query: UMLS:C0018099 (gout)
 5,192 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 77-year-old woman complained of numbness in her hands and feet, progressive unsteadiness, weakness, and loss of proprioception of six months' duration. A myelogram revealed stenosis of the spinal canal at the levels of C2-3, T6-7, L2-3, and L3-4. On computerized tomography scan, a large dorsal, epidural, soft tissue mass and focal calcification of the ligamentum flavum were seen at C3. Laboratory studies ruled out gout, collagen disease, vitamin B12 deficiency, syphilis, parathyroid, and thyroid disease. At decompressive laminectomy, a nodular mass in the ligamentum flavum (C2-4) was found and removed. Three months after operation, the neurologic symptoms had improved. Histologic examination of the elastic ligament revealed deposits of birefringent crystals, which were identified by X-ray diffraction as calcium pyrophosphate dihydrate (CCPD). Only about six cases of myelopathy attributable to deposits of CPPD appear to have been previously reported.
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PMID:Cervical myelopathy attributable to pseudogout. Case report with radiologic, histologic, and crystallographic observations. 379 45

A case of pseudogout manifesting as a cervical myelopathy is presented. Surgery can offer the definitive treatment with removal of the compressing crystalline mass. This diagnosis should be considered in a progressive myelopathy in the elderly person shown to have extradural compression, even in the absence of other stigmata of gout.
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PMID:Cervical myelopathy caused by pseudogout. 778 18

A 60-year-old man with a 5-year history of gout underwent laminectomy for thoracic myelopathy. At operation, white chalky material in the epidural space was found to compress the spinal cord. Laboratory and histologic studies suggested that his myelopathy was caused by a gouty tophus.
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PMID:Thoracic myelopathy due to compression by the epidural tophus: a case report. 818 94

Gouty involvement of the spinal column is not as rare as generally perceived. Tophaceous gout involving the spinal column is a well-documented cause of myelopathy and frank cord compression. It takes several years of gout before bony destruction is radiologically apparent. If erosive or tophaceous gout is present, magnetic resonance imaging signal enhancement offers diagnostic guidance. Non-tophaceous gout of the spine may also show signal enhancement consistent with inflammation. The sequelae of cord compression can be reversed with timely surgical intervention and maintenance of uric acid-lowering therapy; in some cases, medical therapy alone can reverse the findings of radiculopathy. Growing evidence suggests that the tangled web of hypertension, diabetes, and atherosclerotic disease are risk factors for gout and hyperuricemia and may, in fact, be the result of higher than physiologically tolerable levels of uric acid in humans. Here, 52 additional cases to the 73 collated by Hou et al (Surg Neurol. 2007;67:65-73), reinforce that gout is a major contender on the differential diagnosis of back-related presentations in patients at high risk for gout. The pervasiveness of cardiovascular disease and chronic back pain warrants a closer look into a possible occult contributor to the prevalence of chronic back pain: gout.
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PMID:Axial gouty arthropathy. 1968 18

Gout is a common metabolic disease in which monosodium urate crystals called tophi develop. Spinal involvement in gout resulting in neural compression is unusual. We describe a case of a 64-year-old man with a history of gouty arthritis of the knee. The patient presented with thoracic myelopathy and radiculopathy. Imaging of the spine revealed an extradural mass lesion with bony erosion of the thoracic spine. A decompressive operation was performed, and a chalky white material was found. Histopathological examination confirmed a gouty tophus. The symptoms of spinal gout vary and its radiological features are not sufficiently specific to provide a definite diagnosis. Therefore, in patients with a history of gouty arthritis who present with neural compressive symptoms of the spine, spinal gout should be strongly suspected.
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PMID:Tophaceous gout of the spine causing neural compression. 2475 85

Tophaceous gout has classically been described as an affliction of the extremities. It has however been reported as early as 1947 to involve the spinal column. We report a 63-year-old male, previously scheduled for Anterior Cervical Discectomy and Fusion to correct an existing cervical myelopathy at the C3-C4 spinal level, who presented to the emergency room with progressive weakness of the lower extremities and inability to ambulate for three days. Physical examination suggested a possible worsening of his cervical myelopathy but magnetic resonance imaging (MRI) findings remained unchanged from comparison studies. On the day of surgery, he became febrile and complained of excruciating back pain and we therefore initiated an infectious etiology workup and obtained a lumbar spine MRI. Results of imaging suggested a lumbar epidural abscess with effacement of the thecal sac. Emergent L4-L5 decompression led to an evacuation of a "chalky" substance, which was sent for pathology evaluation. This patient was diagnosed with tophaceous gout of the lumbar spine upon final pathological review. We aim to present the management of this case and review the literature associated with this diagnosis with the goal of improving the approach taken to diagnose and treat this pathology.
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PMID:Tophaceous Gout of the Lumbar Spine: Case Report and Review of the Literature. 2661 49

A case of pseudogout manifesting as a cervical myelopathy is presented. Surgery can offer the definitive treatment with removal of the compressing crystalline mass. This diagnosis should be considered in a progressive myelopathy in the elderly person shown to have extradural compression, even in the absence of other stigmata of gout.
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PMID:Cervical myelopathy caused by pseudogout. 2816 19