疑頸椎結石性痛風出現在一四肢無痛風石表徵病人及其核磁共振造影之特徵

Possible Tophaceous Gout of the Cervical Spine without Peripheral Tophi: Report of a Case with Magnetic Resonance Imaging

結石性痛風引起第一頸椎向前性半脫位在痛風病人是一種最嚴重且罕見的併發症。文獻上所報告的病例都是臨床上具有非常嚴重的多發性結石性關節病變。但本篇報告之病人患有三年痛風病史，四肢並無痛風石，在最近六個月發現後枕部疼痛。頸椎X射線攝影發現第一頭椎有向前性半脫位，且第二頸椎之齒樣突有糜爛。核磁共振造影發現第二頸椎之齒樣突有糜爛及周圍有軟組織病灶。病灶內有鈣化點出現。在遲退時間Tl，T2及使用對比劑後之T1，病灶信號的自旋回波波序均變弱。此核磁共振造影表現提示第一頸椎向前性半脫位是因痛風石破壞造成。

Anterior subluxation of the atlas on the axis is one the most serious but rare neurological complications occurring in gouty patients. Most of the reported cases had a long history of severe polyarticular tophaceous gout. We describe a patient with a 3-year history of gout without peripheral tophi. In the recent 6 months, he complained of neck pain which radiated to the occipital area. A cervical radiograph revealed anterior subluxation of the atlas on the axis and ersions of the odontoid process. A magnetic resonance imaging (MRI) of the cervical spine showed osteolytic lesions of the odontoid process and associated periarticular soft tissue masses that contained calcification. The osteolytic lesions had low signal intensity on T1-, T2- and post-enhanced T1-weighted spin echo pulse sequences. The MRI findings suggested that the anterior subluxation of the first and second cervical vertebrae is caused by tophaceous gout.