Crowned dens syndrome

• Main Authors: Norma Belfiore, Vito Privitera, Giampaolo Carmosino, Giulio Doveri
• Format: Article
• Language: English
• Published: PAGEPress Publications 2012-10-01
• Series: Italian Journal of Medicine
• Subjects: Crowned dens; Calcium pyrophosphate dehydrated; Cervical pain; Fever
• Online Access: http://www.italjmed.org/index.php/ijm/article/view/16
• ISSN: 1877-9344; 1877-9352

<p>Introduction <br />Microcrystalline deposition in peri-odontoid articular structures is mainly responsible for acute or chronic cervical pain and is known as “crowned dens syndrome”.</p><p>Materials and methods <br />We described two cases of acute cervical pain associated with onset of fever and peripheral acute monoarthritis. Cervical computed tomography (CT) scan showed linear calcification of the retrodens ligament and calcium pyrophosphate dehydrate (CPPD) crystals were found in synovial fluid of inflamed joints. Both patients were treated with anti-inflammatory drugs and colchicine.</p><p>Discussion <br /> Calcium depositions around the odontoid process of the axis can be occasionally detected by radiological studies. They are frequently asymptomatic but sometimes can be associated with severe neurological abnormalities, fever and acute neck pain. CPPD crystals are usually deposited in joints and bursae but occasionally can disrupt these anatomical confines and deposit in periarticular tissues, sometimes forming large masses confused with tumours.</p><p>Conclusions <br />Acute onset of cervical neck pain associated with elevation of inflammatory indicators and/or signs of cervical myelopathy should suggest CT scans searching for microcrystal depositions in the peryodonthoid tissue. Differential diagnosis of fever of unknown origin (FUO) should include crowned dens syndrome specially in the elderly after exclusion of several endocrine or metabolic disorders, infection diseases (meningitis), arthritis (psoriatic arthritis and ankylosing spondylitis) and tumours (chordoma, meningioma, osteoblastoma).</p>