Crowned Dens Syndrome

Abstract

An 81-year-old woman had recurrent episodes of fever, acute neck pain, and arthritis of the peripheral joints.Radiography of the wrists and knees revealed calcium deposits in the joint spaces (Fig. 1A,B); thus the diagnosis of crystal deposition disease was made although crystallographic analysis was not performed.The tomography of the cervical vertebrae on frontal view revealed calcium deposits surrounding the odontoid process like a crown on a head (Fig. 2).Calcium hydroxyapatite (HA) or calcium pyrophosphate dihydrate (CPPD) crystal deposition disease typically occurs in elderly patients and responds to nonsteroidal anti-inflammatory drugs.Acute neck pain ascribed to HA or CPPD crystal deposits in ligaments around the odontoid process is called the crowned dens syndrome.As demonstrated in this patient, the tomography of the cervical vertebrae is useful in delineating crown-like calcium deposits.This under-recognized disease should be noted as a cause of acute neck pain.