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January 05, 2021; 96 (1) Resident & Fellow Section

Teaching NeuroImages: Intraspinal Gouty Tophus

Meng Si, Menglin Cong, Dandan Wang, Hecheng Ma
First published September 4, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010761
Meng Si
From the Department of Spine (M.S., M.C., H.M.), Qilu Hospital, Shandong University and the Jinan Center Hospital Affiliated to Shandong University (D.W.), Jinan, China.
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Menglin Cong
From the Department of Spine (M.S., M.C., H.M.), Qilu Hospital, Shandong University and the Jinan Center Hospital Affiliated to Shandong University (D.W.), Jinan, China.
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Dandan Wang
From the Department of Spine (M.S., M.C., H.M.), Qilu Hospital, Shandong University and the Jinan Center Hospital Affiliated to Shandong University (D.W.), Jinan, China.
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Hecheng Ma
From the Department of Spine (M.S., M.C., H.M.), Qilu Hospital, Shandong University and the Jinan Center Hospital Affiliated to Shandong University (D.W.), Jinan, China.
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Teaching NeuroImages: Intraspinal Gouty Tophus
Meng Si, Menglin Cong, Dandan Wang, Hecheng Ma
Neurology Jan 2021, 96 (1) e159-e160; DOI: 10.1212/WNL.0000000000010761

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A 49-year-old woman presented to the orthopedic department with a chief complaint of severe low back pain for 2 years, with no neurologic deficiency on physical examination. Laboratory investigations revealed no abnormities. MRI (Figure 1, A and D) showed an intradural mass displacing the posterior spinal cord at the L3 level, leading to lumbar stenosis. Contrast-enhanced MRI (Figure 1, B and E) showed obvious marginal enhancement. CT (Figure 1, C and F) showed that the mass was calcified and the nerve root was compressed. The mass containing tophaceous deposits was removed surgically. As shown in the pathology slide (figure 2), the diagnosis was gouty tophus eventually, which is rarely presented in the spinal canal.1,2 The pain disappeared after the operation.

Figure 1
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Figure 1 Intraspinal Gouty Tophus

Magnetic resonance imaging (A and D, arrow) showed an intradural mass displacing the posterior spinal cord at the L3 level, leading to lumbar stenosis. Contrast-enhanced MRI (B and E, arrow) showed obvious marginal enhancement. CT (C and F, arrow) showed the mass was calcified and the nerve root was compressed.

Figure 2
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Figure 2 The Pathology Slide

Study Funding

Study funding by the financial support from the National Natural Science Foundation of China (81902741), the Science Foundation of Shandong Province (project ZR2019BH077).

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

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Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Teaching slides links.lww.com/WNL/B208

  • © 2020 American Academy of Neurology

References

  1. 1.↵
    1. Blasco JLS,
    2. Sarro NV,
    3. Marnov A,
    4. Martin JJA
    . Cervical cord compression due to intradiscal gouty tophus: brief report. Spine 2012;37: E1534–E1536.
    OpenUrlPubMed
  2. 2.↵
    1. Hasturk AE,
    2. Basmaci M,
    3. Canbay S,
    4. Vural C,
    5. Erten F
    . Spinal gout tophus: a very rare cause of radiculopathy. Eur Spine J 2012;21: 400–403.
    OpenUrlCrossRefPubMed

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