scholarly journals Tophaceous gout in thoracic spine mimicking meningioma: A case report and literature review

2020 ◽  
Vol 11 ◽  
pp. 364
Author(s):  
Ratish Mishra ◽  
Vishnu Prasad Panigrahi ◽  
Nitin Adsul ◽  
Sunila Jain ◽  
R. S. Chahal ◽  
...  
Keyword(s):  
Back Pain ◽  
Cord Compression ◽  
Appendicular Skeleton ◽  
Tophaceous Gout ◽  
Decompressive Laminectomy ◽  
Dural Sac ◽  
Thoracic Spinal ◽  
Spinal Lesion ◽  
Intradural Extramedullary ◽  
Gouty Tophus

Background: Gout is a common metabolic disorder of purine metabolism, causing arthritis in the distal joints of the appendicular skeleton. Spine involvement is rare, and very few cases of spinal gout have been reported. The authors present a rare case of axial gout with tophaceous deposits in the thoracic spinal canal resulting in cord compression and mimicking a meningioma. Case Description: A 33-year-old male presented with chronic mid back pain and a progressive paraparesis. The presumed diagnosis was meningioma based on MR imaging with/without contrast that showed a posterolateral, right-sided, and T10-T11 intradural extramedullary lesion. Notable, was hyperuricemia found on hematological studies. The patient underwent a decompressive laminectomy (T9-T11) for excision of the lesion, intraoperatively, an intraspinal, chalky, white mass firmly adherent to and compressing the dural sac was removed. The histopathology confirmed the diagnosis of a gouty tophus. Postoperatively, the patient’s pain resolved, and he regained the ability to walk. Conclusion: A gouty tophus should be included among the differential diagnostic considerations when patients with known hyperuricemia present with back pain, and paraparesis attributed to an MR documented compressive spinal lesion.

scholarly journals Symptomatic thoracic ossification of the ligamentum flavum in a patient with ankylosing spondylitis: Report of a case and review

2021 ◽  
Vol 12 ◽  
pp. 596
Author(s):  
Abolfazl Rahimizadeh ◽  
Parviz Habibollahzadeh ◽  
Walter L. Williamson ◽  
Housain Soufiani ◽  
Mahan Amirzadeh ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Ankylosing Spondylitis ◽  
Spinal Cord Compression ◽  
Marked Improvement ◽  
Ligamentum Flavum ◽  
Cord Compression ◽  
Case Description ◽  
Thoracic Spinal Cord ◽  
Decompressive Laminectomy ◽  
Thoracic Spinal

Background: Thoracic spinal cord compression due to both ankylosing spondylitis (AS) and ossification of the ligamentum flavum (OLF) is rare. Case Description: A 33-year-old male with AS presented with a paraparesis attributed to MR documented T9-T10 OLF/stenosis. He was successfully managed with a decompressive laminectomy; this resulted in marked improvement of his deficit. Conclusion: Thoracic OLF and AS rarely contribute T9-T10 spinal cord compression that may be readily relieved with a decompressive laminectomy.

Images of thoracic spinal cord compression due to intraspinal gouty tophus in two patients

2016 ◽  
Vol 83 (5) ◽  
pp. 585 ◽  
Author(s):  
Kun Wang ◽  
Jinmin Zhao ◽  
Maolin He ◽  
Mitra Fowdur ◽  
Tenglong Jiang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Gouty Tophus

scholarly journals Gout in the thoracic spine causing acute paraplegia: illustrative case

2021 ◽  
Vol 2 (9) ◽  
Author(s):  
Lacin Koro ◽  
Ryan Khanna ◽  
Dominick Richards ◽  
Dean G. Karahalios
Keyword(s):  
Spinal Cord ◽  
Thoracic Spine ◽  
Clinical Manifestations ◽  
Cord Compression ◽  
Pathological Examination ◽  
Rapid Progression ◽  
Illustrative Case ◽  
Tophaceous Gout ◽  
Thoracic Spinal ◽  
Acute Paraplegia

BACKGROUND Although spinal involvement by gout is not uncommon, spinal gout leading to symptomatic spinal cord compression in the thoracic spine is very rare and poses a diagnostic challenge by mimicking symptoms of more common diagnoses such as epidural abscess and malignancy. An even more unique presentation is spinal gout causing thoracic cord compression leading to acute paraplegia. OBSERVATIONS The authors present an illustrative case of a 35-year-old man with thoracic spinal compression by tophaceous gout who developed rapid progression to complete paraplegia over a 5-day period. Magnetic resonance imaging of the thoracic spine revealed a cystic-appearing lesion within the dorsal extradural space of the lower thoracic spine extending from T8 to T10 accompanied by compression of the spinal cord. An emergent T9–10 laminectomy was performed, and the occupying lesion in the thoracic spine was resected. The diagnosis of spinal tophaceous gout was made by pathological examination. LESSONS Although varying clinical manifestations of spinal gout have been reported in the literature, the patient’s age and the rapid progression to complete paraplegia over a 5-day period reveals a unique presentation that broadens understanding of the manner in which this condition can present and allow more rapid diagnosis and treatment.

scholarly journals Intra-Operative Vertebroplasty Combined with Posterior Cord Decompression

2014 ◽  
Vol 20 (5) ◽  
pp. 583-590 ◽  
Author(s):  
Luca Allegretti ◽  
Nicola Mavilio ◽  
Pietro Fiaschi ◽  
Roberto Bragazzi ◽  
Mattia Pacetti ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Osteoporotic Fractures ◽  
Cord Compression ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Invasive Technique ◽  
Combined Approach ◽  
Single Session ◽  
Decompressive Laminectomy ◽  
Dural Sac

Percutaneous vertebroplasty (VP) is a minimally invasive technique for the treatment of vertebral pathology providing early vertebral stabilization and pain relief. In cases of vertebral pathology complicated by spinal cord compression with associated neurological deficits, VP alone cannot be performed free of risks. We describe a combined approach in which decompressive laminectomy and intra-operative vertebroplasty (IVP) are performed during a single session. Among the 252 VP performed in our centre in the past three years, 12 patients (12 vertebral levels) with different pathologies (six symptomatic haemangiomas, two metastatic fractures, four osteoporotic fractures) were treated with an open procedure combined with surgery. All cases were treated with decompressive laminectomy and IVP (mono/bipeduncular or median-posterior trans-somatic access). Five patients with symptomatic haemangiomas were treated with endovascular embolization prior to the combined approach. A visual analogue scale (VAS) was applied to assess pain intensity before and after surgery. The neurological deficits were evaluated with an ASIA impairment scale. In all cases benefit from pain and neurological deficits was observed. The mean VAS score decreased from 7.8 to 2.5 after surgery. The ASIA score improved in all cases (five cases from D to E and five cases from C to D). No clinical complications were observed. In one case a CT scan performed after the procedure showed a foraminal accumulation of PMMA, but the patient referred no symptoms. IVP can be successfully applied in different pathologies affecting the vertebrae. In our limited series this approach proved safe and efficient to provide decompression of spinal cord and dural sac and vertebral body stabilization in a single session.

Chronic tophaceous gout mimicking widespread metastasis

2021 ◽  
Vol 14 (5) ◽  
pp. e236166
Author(s):  
Joshua W Thompson ◽  
Sriram Srinivasan ◽  
Damodar Makkuni
Keyword(s):  
Differential Diagnosis ◽  
Axial Skeleton ◽  
Cord Compression ◽  
Initial Assessment ◽  
Appendicular Skeleton ◽  
Tophaceous Gout ◽  
Correct Treatment ◽  
Canal Stenosis ◽  
The Right ◽  
The Masses

Gout is a common crystal-induced arthropathy affecting mainly the joints of the appendicular skeleton; however, rarely this condition affects the axial skeleton as well. Spinal gout can cause radiculopathy, cord compression, canal stenosis and discitis. We describe a case of a 71-year-old woman where the initial presentation of destructive arthropathy and spinal masses secondary to axial gout was mistaken for a metastatic malignancy. Despite chronic polyarthropathy and bilateral subcutaneous gouty tophi, spinal gout was not considered a differential diagnosis during initial assessment.The patient was managed conservatively with pharmacological treatment resulting in improvement of her upper limb radiculopathy and systemic joint pain, although little improvement in mobility. Such extensive involvement is rare and the masses can mimic an underlying metastatic disease. Careful history and clinical examination recognising polyarthropathy and subcutaneous tophi can aid the clinician to make the right diagnosis and institute correct treatment. Delay in recognising gout as a differential diagnosis can lead to marked morbidity as illustrated in our case.

scholarly journals Symptomatic thoracic spinal cord compression caused by postsurgical pseudomeningocele

2007 ◽  
Vol 65 (2A) ◽  
pp. 279-282 ◽  
Author(s):  
Arthur de Azambuja Pereira Filho ◽  
Gustavo de David ◽  
Gustavo de Azambuja Pereira Filho ◽  
Albert Vincent Berthier Brasil
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Thoracic Spinal Cord ◽  
Dural Closure ◽  
First Case ◽  
Thoracic Spinal ◽  
Full Neurological Recovery ◽  
Intradural Extramedullary ◽  
Loss Of Strength

We report the first case of symptomatic thoracic spinal cord compression caused by postsurgical pseudomeningocele. A 49-year-old man sought treatment for progressive loss of strength in the lower extremities ten months after full neurological recovery for a thoracic (T11) intradural-extramedullary schwannoma. Magnetic resonance imaging revealed a postsurgical thoracic (T11-T12) pseudomeningocele. The surgical approach showed an inadequate dural closure with spontaneous cerebrospinal fluid fistula. The defect was sealed with suture, muscle and biological glue covering. The patient had a good recovery. Pseudomeningocele must take part of the differential diagnosis of myelopathy after thoracic spine surgery.

Concurrent Thoracic Spinal Intradural Extramedullary Epidermoid and Neurenteric Cyst in a Spinal Dysraphism Child

2021 ◽  
pp. 1-7
Author(s):  
Rajeev Sharma ◽  
Swati Mahajan ◽  
Minakshi Bhardwaj ◽  
Laxmi Naraian Gupta ◽  
Deepak Gupta
Keyword(s):  
Surgical Planning ◽  
English Literature ◽  
Spinal Dysraphism ◽  
Neurenteric Cyst ◽  
Germ Layers ◽  
Case Presentation ◽  
Spinal Lesions ◽  
Congenital Origin ◽  
Thoracic Spinal ◽  
Intradural Extramedullary

<b><i>Introduction:</i></b> Intraspinal epidermoid cysts are congenital or acquired in origin; whereas intraspinal neurenteric cysts (NECs) are of congenital origin. Their individual association with spinal dysraphism and vertebral segmentation anomalies is very well known. <b><i>Case presentation:</i></b> We hereby report a case of concurrent intradural extramedullary epidermoid and NEC at adjacent vertebral levels in a spinal dysraphism child, not reported in English Literature till now. <b><i>Conclusion:</i></b> Multiple spinal lesions related to any/all of the 3 germ layers can coexist at same or adjacent vertebral levels in the same patient and surgical planning shown to be done accordingly.

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