{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:46:47Z","timestamp":1760060807300,"version":"build-2065373602"},"reference-count":8,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>A 56-year-old man, accompanied by city hall staff, visited our neurorehabilitation clinic. Despite hyperuricemia being diagnosed several years ago, he refused treatment. He had no history of hypertension and antihypertensive drug use. He developed painful joint tophi around the age of 51, which were managed with over-the-counter painkillers. At age 54, a knee tophus was removed, histologically confirming gouty tophi. Subsequently, he lost his chef\u2019s job, and his lifestyle deteriorated. Gouty tophi were observed in the right ear, knuckles, elbows, and ankles, with some ulceration. Blood tests showed anemia and hyperuricemia (10.1 mg\/dL: reference 3.6\u20137.0 mg\/dL). Chest\u2013abdominal CT demonstrated calcification of the aorta. Brain MRI revealed an old putaminal hemorrhage and numerous microbleeds. Dementia (Clinical Dementia Rating: 1) was diagnosed based on neuropsychological testing. Public services and social assistance were arranged for him. This case is hypothesis-generating. In settings with adequate healthcare access, the presentation of severe, uncontrolled gouty tophi with poor engagement should prompt a selective, stepwise evaluation\u2014beginning with cognitive screening and proceeding to neurologic assessment if indicated; routine preventive brain imaging is not recommended. The presence of lobar and deep microbleeds should be interpreted within the context of standardized diagnostic criteria and lesion distribution patterns to inform differential diagnosis.<\/jats:p>","DOI":"10.3390\/diagnostics15192424","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T13:48:37Z","timestamp":1758635317000},"page":"2424","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gouty Tophi in Developed Countries: Uncovering Underlying Brain Diseases"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3446-0913","authenticated-orcid":false,"given":"Koji","family":"Hayashi","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami-cho, Fukui 910-8561, Fukui, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2947-9743","authenticated-orcid":false,"given":"Mamiko","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami-cho, Fukui 910-8561, Fukui, Japan"},{"name":"Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami-cho, Fukui 910-3190, Fukui, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuka","family":"Nakaya","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami-cho, Fukui 910-8561, Fukui, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maho","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Fukui General Hospital, 55-16-1 Egami-cho, Fukui 910-8561, Fukui, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toyoaki","family":"Miura","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami-cho, Fukui 910-8561, Fukui, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidetaka","family":"Matsuda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Fukui General Hospital, 55-16-1 Egami-cho, Fukui 910-8561, Fukui, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6305-2444","authenticated-orcid":false,"given":"Yasutaka","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami-cho, Fukui 910-3190, Fukui, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.semarthrit.2012.03.007","article-title":"The broad spectrum of urate crystal deposition: Unusual presentations of gouty tophi","volume":"42","author":"Forbess","year":"2012","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s11926-014-0492-x","article-title":"The gouty tophus: A review","volume":"17","author":"Chhana","year":"2015","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1038\/s41584-020-0441-1","article-title":"Global epidemiology of gout: Prevalence, incidence, treatment patterns and risk factors","volume":"16","author":"Dehlin","year":"2020","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/1477-7525-10-117","article-title":"Tophi and frequent gout flares are associated with impairments to quality of life, productivity, and increased healthcare resource use: Results from a cross-sectional survey","volume":"10","author":"Khanna","year":"2012","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s13047-017-0207-4","article-title":"Clinically-evident tophi are associated with reduced muscle force in the foot and ankle in people with gout: A cross-sectional study","volume":"10","author":"Stewart","year":"2017","journal-title":"J. Foot Ankle Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"368","DOI":"10.3899\/jrheum.160596","article-title":"Predictors of Mortality in People with Recent-onset Gout: A Prospective Observational Study","volume":"44","author":"Vincent","year":"2017","journal-title":"J. Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"128","DOI":"10.46497\/ArchRheumatol.2025.10808","article-title":"Hyperuricemia and the risk of stroke incidence and mortality: A systematic review and meta-analysis","volume":"40","author":"Jiang","year":"2025","journal-title":"Arch. Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1080\/01616412.2022.2067707","article-title":"Can hyperuricemia predict the progression risk of cerebral small vessel disease?","volume":"44","author":"Wei","year":"2022","journal-title":"Neurol. Res."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/19\/2424\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:03Z","timestamp":1760035683000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/19\/2424"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,23]]},"references-count":8,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["diagnostics15192424"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15192424","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,9,23]]}}}