Introduction: Purine-rich diets and improper metabolism of uric acid result in deposition of tophaceous crystals in multiple organs throughout the body. Gout is typically characterized by recurrent attacks of inflammatory arthritis; however, deposition of uric acid crystals in the spinal canal could result in debilitating back pain, neural compression, and progressive myelopathy. While gout is a widely reported source of spinal cord compression, we present the first case of an individual with tophaceous gout of the brain and spinal cord.
Methods: This is a case report of a patient known to our service. Permission was obtained from the patient to present his case.
Results: A 61-year-old, African-American male presented with diplopia, masticatory difficulty, and facial pain. Serial imaging revealed an enlarging, heterogeneously enhancing mass in the left cavernous sinus with extension into the superior orbital fissure and foramen ovale, which raised suspicion for a meningioma. Successful surgical resection of the cavernous lesion was undertaken to eliminate the risk of permanent ophthalmoplegia and blindness. Nine years later, the patient presented with constipation and progressive myelopathy. Imaging of the spine revealed enhancing, intradural lesions similar to calcified meningiomas. Surgical resection was undertaken to preserve motor function. Histophatholgic diagnosis after both operations was consistent with gout.
Conclusions: The pathophysiology of spinal tophaceous gout is well known. However, a tophaceous intracranial lesion causing cranial nerve deficit necessitating surgical resection has not been previously reported. This represents the first reported case of an expansive intracranial tophaceous gouty lesion causing neurological deficits.
Patient Care: My research will improve patient care by increasing awareness of spinal tophaceous gout, as well as describing the first case of intracranial tophaceous gout.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the pathology of spinal tophaceous gout; 2) Learn about the first described case of intracranial tophaceous gout.