A patient with chronic tophaceous gouty arthritis developed paraparesis due to medullar compression from a urate sodium tophus. We report the MRI features of this tophaceous gout, which showed an extradural hyperintense signal with an isointense nodule signal on T1 weighted sequences. Surgical removal of the epidural lesion resulted in complete clinical recovery. At the upper level of the spine, an extension of the epidural lesion was not removed, but after one year of medical treatment of the gout, MRI showed regression of the epidural compression.