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Samuel F. Ciricillo and Philip R. Weinstein

A rticular chondrocalcinosis, or pseudogout, is characterized by the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in hyaline cartilage, periarticular tendons, and ligaments. 3, 7 A rare but serious complication of this disorder is cervical myelopathy; only nine patients with cervical myelopathy attributed to CPPD crystals in the ligamentum flavum have been reported. 1, 5, 6 This paper describes a case of high cervical myelopathy (foramen magnum syndrome) caused by CPPD deposits in the posterior longitudinal ligament and transverse ligament

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Kelly J. Bridges, Carli L. Bullis, Ajay Wanchu and Khoi D. Than

months. 25 Prior trauma to the joint is a strong risk factor, and acute attacks can occur in the setting of illness, joint trauma, or during the postoperative period. 25 Pseudogout is characterized by the accumulation of calcium pyrophosphate dihydrate crystals in the articular and periarticular tissues, 2 , 25 and pathological examination demonstrates positively birefringent rhomboid-shaped crystals in the synovial fluid of the affected joint. 25 Therapy is directed toward reducing inflammation and includes intraarticular glucocorticoids, systemic glucocorticoids

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Bernhard Zünkeler, Robert Schelper and Arnold H. Menezes

+ − + + − + +  sensory loss + − − + + − +  hyperreflexia or long + + + + + + +   tract signs * + = present; − = absent. Calcium pyrophosphate dihydrate deposition disease, also referred to as articular chondrocalcinosis or pseudogout, has several clinical similarities to gout, with the important pathological difference that CPPD crystals are deposited exclusively in joints and bursae, which occasionally disrupt the anatomical confines of the respective joint and form large masses in the periarticular

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Albert J. Fenoy, Arnold H. Menezes, Kathleen A. Donovan and Stephen F. Kralik

individual case reports presented by various other authors. We present an expanded evaluation of pseudogout mass lesions of the CVJ and a review of the relevant literature. Clinical Material and Methods A retrospective analysis of medical records and radiographs (1977–2006) was performed using the University of Iowa Neurosurgery patient database, operative reports, and tumor registry. The inclusion criterion was a histopathological study consistent with a diagnosis of pseudogout (as described above) in the region of the CVJ. Twenty-one such patients were identified

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Gerald A. Grant, Mark H. Wener, Hadi Yaziji, Neal Futran, Mary P. Bronner, Neil Mandel and Marc R. Mayberg

T he crystal deposits responsible for disease in articular and soft tissues include sodium urate, which is responsible for classic gout and gouty tophi; calcium pyrophosphate dihydrate (CPPD), which commonly causes pseudogout and chondrocalcinosis; and calcium hydroxyapatite, which is responsible for most cases of calcific tendonitis and joint capsule calcium deposits. Dense, widespread soft-tissue calcium-containing deposits are termed “tumoral calcinosis” and are usually composed of calcium hydroxapatite. 1 Rarely, tumoral calcinosis has been described to be

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Nobuyuki Kawano, Sanae Yoshida, Takashi Ohwada, Kenzoh Yada, Kenichi Sasaki and Takashi Matsuno

S ince the detailed descriptions by Žitňan and Sit'aj, 10 and by McCarty, et al. , 5, 6 the clinical syndrome associated with calcification of the articular cartilage has received increased attention in the past several years. Žitňan and Sit'aj 10 described the entity as “articular chondrocalcinosis” from their roentgenological observations. At about the same time, McCarty, et al. , 5, 6 analyzed deposited crystals from the inflamed joint and confirmed them to be calcium pyrophosphate dihydrate (CPPD). They preferred the term “pseudo-gout syndrome

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Vincent Baty, Bénédicte Prost, Anne Jouvet, Jacques Laurent and Bernard Vallée

arthropathy of the spine: case report and review of the literature. Neurosurgery 34: 915–918, 1994 4. Steinbach LS , Resnick D : Calcium pyrophosphate dihydrate crystal deposition disease revisited. Radiology 200 : 1 – 9 , 1996 Steinbach LS, Resnick D: Calcium pyrophosphate dihydrate crystal deposition disease revisited. Radiology 200: 1–9, 1996 5. Zünkeler B , Schelper R , Menezes AH : Periodontoid calcium pyrophosphate dihydrate deposition disease: “pseudogout” mass lesions of the craniocervical

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Yoshinobu Iwasaki, Minoru Akino, Hiroshi Abe, Mitsuo Tsuru, Kunio Tashiro, Kazuo Miyasaka, Kiyoshi Kaneda, Toyohiko Isu and Terufumi Ito

flavum. 2, 5, 16, 18 Ellman, et al. , 3 and Kawano, et al. , 8 have suggested that the calcification might be induced by CPPD deposits, as seen in cases of pseudo-gout. On the other hand, Jyotoku and Harada 7 and Kida and Tabata 9 have postulated that degeneration of the elastic fiber of the ligamentum flavum due to an abnormal nutritional condition might be a contributing factor causing calcification. However, the precise cause has not yet been established. In our Case 2, an episode of arthritis of the knee was described clinically, and a non-acute phase of

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Karthik Madhavan, Lee Onn Chieng, Brandon G. Gaynor and Allan D. Levi

T he atlantoaxial joint represents an intricately balanced bone-ligament complex. Calcium pyrophosphate deposition (CPPD) or pseudogout in the upper cervical spine was described initially by Menezes and colleagues. 15 , 57 These benign cystic lesions are located in the retro-odontoid and peri-odontoid areas and are composed of fibrocartilaginous debris. Symptomatic lesions require resection, and several surgical options are often available, including those performed through an anterior transoral/endoscopic transnasal, far-lateral, or posterior extradural

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Adam S. Wu and Daryl R. Fourney

crystal deposition. All three patients were asymptomatic for pseudogout, and thus follow-up investigations for pseudogout were not performed. TABLE 2. Summary of cases with benign (noninfectious and nonneoplastic) indications for surgery Indication No. of Specimens No. of Procedures DDD  cervical 269 247  thoracic, lumbar, lumbosacral 1133 1109  level not specified 26 25 foraminal stenosis  cervical 8 8  thoracic, lumbar, lumbosacral 2 2 spinal stenosis  cervical 10 10