Spinal cord compression: an unusual neurological complication of gout

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Abstract
We report the case of a 60‐yr‐old dental technician who presented in 1997 with a 6‐week history of progressive right leg weakness. In addition he complained of damp underwear for 2–3 weeks and 3 days of nocturnal incontinence. He had previously been seen in 1989 with progressive weakness of all four limbs; was found to have a quadraparesis and was diagnosed as having both cervical and lumbar canal stenoses. Anterior decompression of the cervical spine at the C5/6 level was performed with some improvement in upper limb function. Because of persistent leg weakness, he underwent L2–4 decompressive lumbar laminectomy the following year and made a good functional recovery, and was able to return to work. He was known to have gout, for which he took allupurinol 300 mg daily, and had not suffered an acute attack for 10 yr. He had had polio as a child and had been left with residual left leg weakness. General examination revealed a wheelchair‐bound middle‐aged man who smelt of urine. There were no peripheral stigmata of gout. Examination of the cranial nerves and upper limbs was normal. Examination of the lower limbs demonstrated a wasted left leg with reduced muscle tone and MRC grade 3 weakness, compatible with the early history of polio. Muscle tone was also decreased in the right leg, power was well preserved proximally but he was MRC grade 3 distally. Sensory testing demonstrated a level to pinprick on the left below T4 and some impairment of joint position sense in the right leg. Lower limb reflexes were bilaterally absent and his right plantar was extensor. His bladder was painlessly distended and his anal sphincter tone was reduced. Because of the demonstrated hemisensory level on the left and the new right‐side leg weakness and right extensor plantar, the Brown–Séquard syndrome was diagnosed.