1
|
Stevanovic Sancar B, Günen Yılmaz S. A retrospective study of the prevalence of calcium deposits around the dens axis via cone beam computed tomography. Cranio 2024:1-5. [PMID: 38785099 DOI: 10.1080/08869634.2024.2355856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVE This study aimed to evaluate the relationship between the presence of calcium deposits (CDs) around the dens axis and patients' age, gender, and systemic diseases. METHODS This retrospective study was carried out by examining CBCT. Basic descriptive statistical analyses and normality tests were performed on all variables. The assumption of normality was checked using the Shapiro-Wilk method. The statistical significance level was accepted as a p-value less than 0.05. RESULTS CDs were observed in a total of 99 (21.9%) individuals. The incidence of CDs statistically significantly increased with age (p < .01),while it didn't statistically significantly differ between genders (p = .47). 13% were systemically healthy, while 55% had hypertension. The incidence of CDs was statistically significantly higher in individuals with hypertension. CONCLUSIONS In the presence of CDs, the patient should be referred to a medical doctor to confirm the diagnosis of CDS and prevent possible complications.
Collapse
Affiliation(s)
- Bilay Stevanovic Sancar
- Faculty of Dentistry; Department of Oral and Maxillofacial Radiology, Akdeniz University, Antalya, Turkey
| | - Sevcihan Günen Yılmaz
- Faculty of Dentistry; Department of Oral and Maxillofacial Radiology, Akdeniz University, Antalya, Turkey
| |
Collapse
|
2
|
Lim MY, Ho Shon I, Sammel AM. Clinical Images: Crowned dens syndrome detected on 18F-fludeoxyglucose-positron emission tomography/computed tomography during investigation for giant cell arteritis. Arthritis Rheumatol 2024; 76:664-665. [PMID: 38105657 DOI: 10.1002/art.42777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Miao Yunn Lim
- Department of Rheumatology, Prince of Wales Hospital, Sydney, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
| | - Ivan Ho Shon
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- Department of Nuclear Medicine and PET, Prince of Wales Hospital, Sydney, Australia
| | - Anthony M Sammel
- Department of Rheumatology, Prince of Wales Hospital, Sydney, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Voulgari PV, Venetsanopoulou AI, Drosos AA. Recent advances in the therapeutic management of calcium pyrophosphate deposition disease. Front Med (Lausanne) 2024; 11:1327715. [PMID: 38529115 PMCID: PMC10961350 DOI: 10.3389/fmed.2024.1327715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/26/2024] [Indexed: 03/27/2024] Open
Abstract
Calcium pyrophosphate deposition (CPPD) disease is a form of crystal-induced arthropathy that arises from the accumulation of calcium pyrophosphate crystals within joints and soft tissues. This process leads to inflammation and damage to the affected joints. It can present asymptomatically or as acute or chronic inflammatory arthritis. Risk factors and comorbidities, including prior joint injury, osteoarthritis, hereditary or familial predisposition, and metabolic diseases, should be evaluated in CPPD cases. The management of CPPD remains a challenge in the sparsity of randomized controlled trials. The lack of such trials makes it difficult to establish evidence-based treatment protocols for CPPD. This review provides an overview of the current pharmacological management of CPPD, focusing on reducing inflammation, alleviating symptoms, and preventing acute flares. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and colchicine are effective in managing acute CPP arthritis. Colchicine may also be used prophylactically to prevent recurrent flares. In cases where other treatments have failed, anakinra, an interleukin-1 receptor antagonist, can be administered to alleviate acute flares. The management of chronic CPP inflammatory arthritis includes NSAIDs and/or colchicine, followed by hydroxychloroquine, low-dose glucocorticoids, and methotrexate, with limited data on efficacy. Tocilizumab can be used in refractory cases. In small studies, synovial destruction using intra-articular injection of yttrium 90 can decrease pain. To date, no disease-modifying therapies exist that reduce articular calcification in CPPD.
Collapse
Affiliation(s)
- Paraskevi V. Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | | | | |
Collapse
|
4
|
McBride N, Swaminathan S, Nagaraja V. A 64-Year-Old Man with Joint Pain. NEJM EVIDENCE 2023; 2:EVIDmr2200337. [PMID: 38320131 DOI: 10.1056/evidmr2200337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
A 64-Year-Old Man with Joint PainA 64-year-old man presented for evaluation of acute oligoarticular joint pain. How do you approach the evaluation, and what is the diagnosis?
Collapse
Affiliation(s)
- Nolan McBride
- from the Mayo Clinic Arizona Rheumatology and Nephrology Fellowship Programs
| | | | - Vivek Nagaraja
- from the Mayo Clinic Arizona Rheumatology and Nephrology Fellowship Programs
| |
Collapse
|
5
|
Isono H, Kuno H, Hozumi T, Emoto K, Nishiguchi S, Sakai M, Ito M, Kitamura K, Hirose K, Hiraoka E, Ishimaru N, Kobayashi H, Tokuda Y. Crowned dens syndrome: A case series of 72 patients at eight teaching hospitals in Japan. J Gen Fam Med 2023; 24:171-177. [PMID: 37261038 PMCID: PMC10227743 DOI: 10.1002/jgf2.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 06/02/2023] Open
Abstract
Background Crowned dens syndrome (CDS) is characterized by calcification around the odontoid process, accompanied by neck pain. Although CDS is supposedly rare, we regularly diagnose and manage this condition, indicating a perception gap between previous studies and our experience. The purpose of this study was to determine the annual incidence of CDS, time to diagnosis in CDS, as well as the features of CDS. Methods The study design was a retrospective case series study conducted at eight teaching hospitals in Japan. We identified CDS cases from April 2013-March 2015. CDS was diagnosed when patients had acute onset of neck pain and CT showed calcification around the dens and when other diagnoses were unlikely. Results Seventy-two CDS cases were identified. Mean annual incidence was 4.6 ± 2.3 cases at each hospital. Among those with available data, 57 of 64 had limited rotation (89.1%). The diagnosis of CDS was made in general internal medicine or the emergency medicine department in 61 cases (84.7%). A total of 62 cases (86.1%) were diagnosed within 1 day of presentation, and the median time from initial presentation at the hospital to diagnosis was 0.0 days (25th-75th percentiles, 0.0-1.0). For treatment, NSAIDs were used in 56cases (77.8%) and acetaminophen in 20 cases (27.8%). Conclusion CDS might be more common than has been reported to date. Time to diagnosis of CDS was within 1 day of visiting a teaching hospital. Cervical motion restriction is common in CDS and may be useful in establishing the diagnosis.
Collapse
Affiliation(s)
- Hiroki Isono
- Department of General MedicineHITO Medical CenterEhimeJapan
| | - Haruka Kuno
- Department of Family Medicine, General Practice and Community Health, Faculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Takunori Hozumi
- Department of General Internal MedicineKameda Medical CenterChibaJapan
| | - Ken Emoto
- Department of General Internal MedicineAso Iizuka HospitalFukuokaJapan
| | - Sho Nishiguchi
- Department of General Internal MedicineShonan Kamakura General HospitalKanagawaJapan
| | - Masahiro Sakai
- Department of NephrologyEndocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical CenterChibaJapan
| | - Madoka Ito
- Department of Palliative MedicineKobe University Graduate School of MedicineHyogoJapan
| | - Koichi Kitamura
- Department of NephrologyEndocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical CenterChibaJapan
| | - Kazuhito Hirose
- Department of General MedicineTsukuba Medical Center HospitalIbarakiJapan
| | - Eiji Hiraoka
- Department of Internal MedicineTokyo Bay Urayasu Ichikawa Medical CenterChibaJapan
| | - Naoto Ishimaru
- Department of General Internal MedicineAkashi Medical CenterHyogoJapan
| | | | - Yasuharu Tokuda
- Department of Medicine, Muribushi Okinawa Center for Teaching HospitalsOkinawaJapan
| |
Collapse
|
6
|
Naim T, Khan D, Ali M, Fanciullo J. Crowned Dens Syndrome: A Challenging Diagnosis in Older Adults Presenting With Acute Neck Pain. Cureus 2023; 15:e37101. [PMID: 37153310 PMCID: PMC10158671 DOI: 10.7759/cureus.37101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Crowned dens syndrome (CDS) is a rare syndrome of calcium pyrophosphate dihydrate (CPPD) deposition on the odontoid process of the second cervical vertebra leading to unique clinical presentation and radiographical findings. Symptoms usually overlap with more common etiologies, including meningitis, stroke, and giant cell arteritis. Thus, patients struggle with extensive evaluation before diagnosing this uncommon condition. There are few case reports and case series of CDS in the literature. Patients respond well to treatment, but unfortunately, there is a high rate of relapse. Here we present an interesting case of a 78-year-old female patient who presented with acute onset headache and neck pain.
Collapse
Affiliation(s)
- Touba Naim
- Internal Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, USA
| | - Dawlat Khan
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Mohammad Ali
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Joseph Fanciullo
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| |
Collapse
|
7
|
Michel J, Bedel JB, Pinson C, Joly LM. Crowned dens syndrome: An uncommon mimic of meningitis in the emergency department. Am J Emerg Med 2023; 63:180.e1-180.e3. [PMID: 36336537 DOI: 10.1016/j.ajem.2022.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Crowned dens syndrome is characterized by severe neck pain with stiffness of the neck, sometime febrile, due to calcification of the transverse atlas ligament. We describe the case of a 65-year-old woman referred to the emergency department with a suspicion of meningitis. Several anamnestic and clinical signs ruled out this hypothesis. Re-evaluation of the CT images enabled us to reach the final diagnosis of crowned dens syndrome.
Collapse
Affiliation(s)
- Johnny Michel
- Emergency Department, Rouen University Hospital, F 76000 Rouen, France.
| | | | - Cécile Pinson
- Radiology Department, Rouen University Hospital, F 76000 Rouen, France
| | - Luc-Marie Joly
- Emergency Department, Rouen University Hospital, F 76000 Rouen, France
| |
Collapse
|
8
|
Oliveira D, Vaz C. Crowned dens syndrome as a rare cause of severe cervical pain. REUMATOLOGIA CLINICA 2022; 18:495-496. [PMID: 36210143 DOI: 10.1016/j.reumae.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/10/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Daniela Oliveira
- Rheumatology Department, University Hospital Center of São João, Porto, Portugal; Department of Medicine of Faculty of Medicine, University of Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Carlos Vaz
- Rheumatology Department, University Hospital Center of São João, Porto, Portugal; Department of Medicine of Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
9
|
Lee J, Cheah J, Paudel P. Crowned Dens Syndrome Presenting as Altered Mental Status. Am J Med 2022; 135:e366-e367. [PMID: 35476914 DOI: 10.1016/j.amjmed.2022.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Joshua Lee
- Department of Medicine, UMass Chan Medical School, Worcester.
| | - Jonathan Cheah
- Department of Rheumatology, UMass Chan Medical School, Worcester
| | - Prakash Paudel
- Department of Medicine, UMass Chan Medical School, Worcester
| |
Collapse
|
10
|
Nogueira Gomes T, Camelo Pereira M, Pinheiro Alves A, Madeiro M. Crowned Dens Syndrome: A Rare Complication of Calcium Pyrophosphate Crystal Deposition Disease. Cureus 2022; 14:e25593. [PMID: 35785005 PMCID: PMC9249022 DOI: 10.7759/cureus.25593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Crowned dens syndrome (CDS) is a clinical entity characterized by neck pain associated with fever, headaches, and neck stiffness, along with radiologic evidence of peri-odontoid process calcification in a characteristic “crown” or “halo” distribution. It is likely an underdiagnosed condition and patients can initially be misdiagnosed, leading to costly evaluation and unnecessary treatment interventions. We present the case of a 76-year-old man who presented to the emergency department (ED) with a 3-day history of progressively worsening neck pain that was associated with headaches, malaise, decreased oral intake, chills, and fever. Initial evaluation was significant for the presence of fever, tachycardia, and elevated inflammatory markers. We report a case of CDS attributed to calcium pyrophosphate deposition and review the pertinent literature about the presentation, diagnostic evaluation, and treatment of this rare clinical entity.
Collapse
|
11
|
Haas P, Hauser TK, Kandilaris K, Skardelly M, Tatagiba M, Adib SD. Case Report: Posterolateral Epidural Supra-C2-Root Approach (PESCA) for Biopsy of a Retro-Odontoid Lesions in Same Sitting After Occipitocervical Fixation and Decompression in a Case of Crowned Dens Syndrome With Brainstem Compression and Displacement. Front Surg 2022; 9:797495. [PMID: 35558389 PMCID: PMC9086508 DOI: 10.3389/fsurg.2022.797495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background ‘Crowned dens syndrome' (CDS) is a special form of calcium pyrophosphate dihydrate deposition disease which is characterized radiologically by a halo-like or crown-like distribution in the periodontoid region and clinically by cervical pain. Herein, we will describe our experience of posterolateral epidural supra-C2-root approach (PESCA) for biopsy of retro-odontoid lesions in one surgical session after occipitocervical fixation and decompression in a patient with CDS and massive brainstem compression. Case Presentation A 70-year-old woman presented to our department with a 4-week history of progressive walking impairment, neck pain, neck rigidity, fever, dizziness, slight palsy of the left hand, and multiple fall episodes. Magnetic resonance imaging (MRI) of the craniovertebral junction (CVJ) and cervical spine revealed a lesion of the odontoid process and the retro-odontoid region with mainly solid components, as well as small cystic components, and brainstem compression and displacement. In first step, fusion surgery of the CVJ C0–C4 was performed with occiptocervical decompression. After fusion and decompression the lower lateral part of the C1 arc and the lateral superior part of the left side of the C2 arc were removed. The entry point was located directly above the superior part of the C2 root. A biopsy of the lateral portions of the lesions was obtained by bioptic forceps under microscope guidance. Pathologic examination of the mass revealed deposition of birefringent crystals compatible with calcium pyrophosphate. In addition to the clinical symptoms (especially neck pain), the diagnosis of CDS was made. Non-steroidal inflammatory drugs (NSAIDs) and colchicine (and later magnesium) were started. At follow-up examination 6 months after surgery, an MRI scan of the cervical spine revealed regression of the pannus and the cyst with replacement of the brainstem, clinical improvement of walking, and increased strength of the left hand. Conclusions This study demonstrates that PESCA can be used to obtain tissue for pathological analysis in one surgical sitting after fusion and decompression and that fusion, decompression, and PESCA (in the same session) together with subsequent conservative management could be a good alternative for the treatment of CDS.
Collapse
Affiliation(s)
- Patrick Haas
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Till-Karsten Hauser
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Kosmas Kandilaris
- Department of Neuropathology, University of Tübingen, Tübingen, Germany
| | - Marco Skardelly
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Sasan Darius Adib
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
- *Correspondence: Sasan Darius Adib
| |
Collapse
|
12
|
Evangelatos G, Grivas A, Pappa M, Kouna K, Iliopoulos A, Fragoulis GE. Cranial giant cell arteritis mimickers: A masquerade to unveil. Autoimmun Rev 2022; 21:103083. [PMID: 35341973 DOI: 10.1016/j.autrev.2022.103083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/23/2022] [Indexed: 12/20/2022]
Abstract
Giant cell arteritis (GCA) is a large-vessel vasculitis that affects cranial and extra-cranial arteries. Extra-cranial GCA presents mainly with non-specific symptoms and the differential diagnosis is very broad, while the cranial form has more typical clinical picture and physicians have a lower threshold for diagnosis and treatment. Although temporal artery biopsy (TAB) has an established role, ultrasound (US) is being increasingly used as the first-line imaging modality in suspected GCA. Vasculitides (especially ANCA-associated), hematological disorders (mainly amyloidosis), neoplasms, infections, atherosclerosis and local disorders can affect the temporal arteries or might mimic the symptoms of cranial GCA and produce US and TAB findings that resemble those of temporal vasculitis. Given that prompt diagnosis is essential and proper treatment varies significantly among these diseases, in this review we aimed to collectively present disorders that can masquerade cranial GCA.
Collapse
Affiliation(s)
- Gerasimos Evangelatos
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Alexandros Grivas
- Clinical Immunology-Rheumatology Unit, Fourth Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Kouna
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - Alexios Iliopoulos
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - George E Fragoulis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
13
|
Aoki N, Miyagami T, Shikino K, Yang KS, Naito T. Polymyalgia Rheumatica in a Patient with Pseudogout and Dementia. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933926. [PMID: 34811343 PMCID: PMC8628562 DOI: 10.12659/ajcr.933926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patient: Female, 88-year-old
Final Diagnosis: Polymyalgia rheumatica
Symptoms: Fever and generalized pain
Medication:—
Clinical Procedure: —
Specialty: Rheumatology
Collapse
Affiliation(s)
- Nozomi Aoki
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Taiju Miyagami
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University, Chiba, Japan
| | - Kwang-Seok Yang
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW Calcium pyrophosphate deposition disease (CPPD) arises from calcium pyrophosphate deposition throughout the body, leading to different clinical syndromes that may be diagnosed using various imaging modalities. The purpose of this review is to highlight recent updates in the imaging of CPPD. RECENT FINDINGS Conventional radiography remains the initial test when imaging CPPD; but musculoskeletal ultrasound and conventional computed tomography (CT) may also assist in diagnosing and characterizing CPP deposits, with increased sensitivity. Dual-energy CT is also being used to differentiate CPP crystals from other crystal deposition diseases. CPP discitis has been diagnosed with MRI, but MRI has lower sensitivity and specificity than the aforementioned imaging studies in CPPD diagnosis. Assorted imaging modalities are increasingly used to diagnose CPPD involving atypical joints, avoiding invasive procedures. Each modality has its advantages and disadvantages. Future imaging may be able to provide more utility than what is currently available.
Collapse
|
15
|
Qin X, Hu X, Wang Q, Zeng J, Chen J. A rare acute neck pain cause that can have misdiagnosis or missed diagnosis-crowned dens syndrome: description of two cases and a literature analysis. Quant Imaging Med Surg 2021; 11:4491-4496. [PMID: 34604002 DOI: 10.21037/qims-20-1347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/13/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Xin Qin
- Department of Radiology, Xingyi People's Hospital, Qian Xi'Nan, Gui Zhou, China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Qingzhen Wang
- Department of Radiology, Xingyi People's Hospital, Qian Xi'Nan, Gui Zhou, China
| | - Jigang Zeng
- Department of Radiology, Xingyi People's Hospital, Qian Xi'Nan, Gui Zhou, China
| | - Jie Chen
- Department of Radiology, Xingyi People's Hospital, Qian Xi'Nan, Gui Zhou, China
| |
Collapse
|
16
|
Gorman J, Van Der Westhuizen A, Raheez Qamar S, Funnell C. Mimicking Meningismus: A Case of Atlantoaxial Gout. Neurol Clin Pract 2021; 11:e353-e355. [PMID: 34484912 DOI: 10.1212/cpj.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/30/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Johnathon Gorman
- Division of Neurology (JG, CF), and Department of Radiology (AVDW), University of British Columbia, Vancouver; and Department of Medical Imaging (SRQ), University of Toronto, Ontario, Canada
| | - Andrew Van Der Westhuizen
- Division of Neurology (JG, CF), and Department of Radiology (AVDW), University of British Columbia, Vancouver; and Department of Medical Imaging (SRQ), University of Toronto, Ontario, Canada
| | - Sadia Raheez Qamar
- Division of Neurology (JG, CF), and Department of Radiology (AVDW), University of British Columbia, Vancouver; and Department of Medical Imaging (SRQ), University of Toronto, Ontario, Canada
| | - Clark Funnell
- Division of Neurology (JG, CF), and Department of Radiology (AVDW), University of British Columbia, Vancouver; and Department of Medical Imaging (SRQ), University of Toronto, Ontario, Canada
| |
Collapse
|
17
|
Bamgboje AO, Mohandas N. Crowned Dens Syndrome Masquerading as Meningitis. Cureus 2021; 13:e12678. [PMID: 33598372 PMCID: PMC7880003 DOI: 10.7759/cureus.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The classic symptoms of meningismus, including fever, neck stiffness, and headache, should automatically trigger a prime differential of meningitis, but a close masquerader, albeit rare, is crowned dens syndrome. Herein, we report the case of a 71-year-old woman with clinical features of meningismus with elevated inflammatory biomarkers. However, computed tomography of the cervical spine revealed the presence of calcium deposits encircling the dens. Hence, an alternate diagnosis of crowned dens syndrome was considered. This was confirmed by the presence of similar pathology in other joints and the dramatic resolution of symptoms and inflammatory markers with the administration of nonsteroidal anti-inflammatory drugs.
Collapse
Affiliation(s)
- Abayomi O Bamgboje
- Internal Medicine, New York City Health + Hospitals/Metropolitan, New York, USA
| | - Nirupa Mohandas
- Internal Medicine/Rheumatology, New York City Health + Hospitals/Metropolitan, New York, USA
| |
Collapse
|
18
|
Lage C, Grognet A, Cudennec T, Sellier C. [Not Available]. SOINS. GERONTOLOGIE 2021; 26:47-48. [PMID: 33549242 DOI: 10.1016/j.sger.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Cindy Lage
- Assistance publique-Hôpitaux de Paris, université Paris-Saclay, site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Alix Grognet
- Assistance publique-Hôpitaux de Paris, université Paris-Saclay, site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Tristan Cudennec
- Assistance publique-Hôpitaux de Paris, université Paris-Saclay, site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - Cyril Sellier
- Assistance publique-Hôpitaux de Paris, université Paris-Saclay, site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| |
Collapse
|
19
|
Tang J, Li J, Wu C, Li Y, Lu Q, Xie W, Zhang T, Li X. Report of four cases of crowned dens syndrome: Clinical presentation, CT findings and treatment. Exp Ther Med 2020; 20:3853-3859. [PMID: 32905161 PMCID: PMC7465381 DOI: 10.3892/etm.2020.9128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 07/21/2020] [Indexed: 12/05/2022] Open
Abstract
The clinical manifestations of crowned dens syndrome (CDS) include acute neck pain and neck stiffness accompanied by restricted cervical range of motion. CDS is frequently misdiagnosed as meningitis, epidural abscess, rheumatoid arthritis, rheumatoid polymyalgia, giant cell arteritis, cervical spondylosis or metastatic bone tumor, and the incidence of CDS appears to be underestimated. The present study reported on four cases of CDS diagnosed by CT. They included one male and three females, aged from 67 to 78 years, and their major symptoms were acute neck pain and restricted cervical range of motion. Serum C-reactive protein levels and erythrocyte sedimentation rate were significantly increased in all cases. Cervical CT scan revealed calcified deposits surrounding the odontoid process in all cases. Non-steroidal anti-inflammatory drugs (NSAIDs) markedly reduced the levels of inflammatory indicators and rapidly relieved the symptoms. CT scan is considered the gold standard for CDS diagnosis, which may demonstrate calcification around the odontoid process. The patients' symptoms may be improved by treatment with NSAIDs.
Collapse
Affiliation(s)
- Jin Tang
- Department of Minimally Invasive Spinal Surgery, Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei 430079, P.R. China
| | - Junjie Li
- Department of Minimally Invasive Spinal Surgery, Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei 430079, P.R. China
| | - Congjun Wu
- Department of Minimally Invasive Spinal Surgery, Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei 430079, P.R. China
| | - Ying Li
- Department of Minimally Invasive Spinal Surgery, Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei 430079, P.R. China
| | - Qilin Lu
- Department of Minimally Invasive Spinal Surgery, Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei 430079, P.R. China
| | - Wei Xie
- Department of Minimally Invasive Spinal Surgery, Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei 430079, P.R. China
| | - Tonghui Zhang
- Department of Minimally Invasive Spinal Surgery, Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei 430079, P.R. China
| | - Xugui Li
- Department of Minimally Invasive Spinal Surgery, Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei 430079, P.R. China
| |
Collapse
|
20
|
Kenny G, MacMahon P, Dempsey P, Muldoon E, Sheehan G, McCarthy GM. The need for computed tomography imaging to differentiate the crowned dens syndrome from vertebral osteomyelitis. Scand J Rheumatol 2020; 49:249-250. [PMID: 32154755 DOI: 10.1080/03009742.2020.1719542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- G Kenny
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland
| | - P MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - P Dempsey
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - E Muldoon
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - G Sheehan
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - G M McCarthy
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
21
|
Salaffi F, Carotti M, Di Carlo M, Sessa F, Malavolta N, Polonara G, Giovagnoni A. Craniocervical junction involvement in musculoskeletal diseases: an area of close collaboration between rheumatologists and radiologists. Radiol Med 2020; 125:654-667. [DOI: 10.1007/s11547-020-01156-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
|
22
|
Haikal A, Everist BM, Jetanalin P, Maz M. Cervical CT-Dependent Diagnosis of Crowned Dens Syndrome in Calcium Pyrophosphate Dihydrate Crystal Deposition Disease. Am J Med 2020; 133:e32-e37. [PMID: 31369722 DOI: 10.1016/j.amjmed.2019.06.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study is to assess the presence of crowned dens syndrome in patients with calcium pyrophosphate disease. We report 34 patients with crowned dens syndrome in one of the largest series from a single tertiary medical center in North America. METHODS A retrospective chart review was conducted at the University of Kansas Medical Center from November 1, 2005-November 1, 2017. A total of 191 patients with calcium pyrophosphate disease were identified. The available cervical computed tomography scans were analyzed by a musculoskeletal radiologist for the presence of periodontoid calcifications and erosions. RESULTS Of the 191 patients with calcium pyrophosphate disease, 57 had cervical computed tomography scans; 34 of them (34/57, 59.64%) had periodontoid calcifications. Only 12/34 patients were formally evaluated and diagnosed by rheumatologists with crowned dens syndrome. Twenty-two of 34 were either not seen by a rheumatologist or were not diagnosed with crowned dens syndrome. The median age was 78.5 years, with 73.52% over 70 years old; 24/34 (70.58%) were female; 17/34 patients (50%) were symptomatic; 28/34 (82.35%) had additional sites of chondrocalcinosis on available radiographs; 8 (28.57%) had 3 or more sites of chondrocalcinosis in typical calcium pyrophosphate disease locations. Six patients did not have any radiographs. CONCLUSION Crowned dens syndrome is an under-recognized entity that should be considered in elderly patients with neck pain in the setting of calcium pyrophosphate disease. Our data demonstrated a high percentage (about 60%) of patients with calcium pyrophosphate disease who had cervical computed tomography findings consistent with crowned dens syndrome. This underscores the importance of performing cervical computed tomography when evaluating patients with neck pain and calcium pyrophosphate disease.
Collapse
Affiliation(s)
- Ammar Haikal
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Internal Medicine.
| | - Brian M Everist
- Musculoskeletal Division, Department of Radiology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Pim Jetanalin
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Internal Medicine
| | - Mehrdad Maz
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Internal Medicine
| |
Collapse
|
23
|
Heck A, Nolan N, Rojas-Moreno C. Crowned Dens Syndrome: Calcium Pyrophosphate Deposition Disease Masquerading as Osteomyelitis. J Rheumatol 2019; 45:1422-1423. [PMID: 30275340 DOI: 10.3899/jrheum.170921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Christian Rojas-Moreno
- Department of Medicine, Divisions of Infectious Diseases and Hospital Medicine, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
24
|
Scheldeman L, Van Hoydonck M, Vanheste R, Theys T, Cypers G. Crowned dens syndrome: a neurologist's perspective. Acta Neurol Belg 2019; 119:561-565. [PMID: 31127531 DOI: 10.1007/s13760-019-01153-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
Crowned dens syndrome is an under-recognized entity that can mimic neurological disease, in particular meningitis or giant-cell arteritis. We present a 48-year-old woman presenting with an inflammatory meningitis-like syndrome with headache and neck stiffness. Lumbar puncture was normal and computed tomography (CT) of the atlantoaxial joint showed abnormal calcifications around the odontoid process, leading to a tentative diagnosis of crowned dens syndrome. In addition, signs of active inflammation in and around the dens were present on cervical MR imaging. Since CDS can mimic meningitis or giant-cell arteritis, neurologists should be aware of this entity. If CDS is suspected, the bone window on the head CT scan can lead to the diagnosis. On the other hand, asymptomatic periodontoid calcifications are common and should not preclude further investigations.
Collapse
|
25
|
Awisat A, Rosner I, Rimar D, Rozenbaum M, Boulman N, Kaly L, Silawy A, Jiries N, Ginsberg S, Hussein H, Slobodin G. Crowned dens syndrome, yet another rheumatic disease imposter. Clin Rheumatol 2019; 39:571-574. [PMID: 31713735 DOI: 10.1007/s10067-019-04822-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/17/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Crowned dens syndrome (CDS) is defined as acute cervical or occipital pain due to a local inflammatory reaction related to calcifications in the ligaments surrounding the odontoid process. Virtually, all previous descriptions of CDS have related to calcium pyrophosphate dehydrate (CPPD) arthropathy. METHODS We prospectively identified a total of twenty-four consecutive inpatients with Crowned dens syndrome from January 2016 to December 2017 in our institution. RESULTS All patients (age range 54 to 87 years, 67% females) presented with acute onset pain in the upper neck and/or occiput accompanied with extreme neck stiffness. Most patients (79%) had elevated inflammatory markers. Four patients underwent temporal artery biopsy, which was negative for arteritis in all cases, and one was subjected to lumbar puncture, which was non-contributory. Seventeen patients (71%) had known rheumatic disease on presentation: 10 patients had the diagnosis of calcium pyrophosphate dehydrate arthropathy, 3 patients had ankylosing spondylitis, 2 patients had rheumatoid arthritis, 1 patient had Behcet's disease, and 1 suffered from Familial Mediterranean Fever. In 4 more patients, crowned dens syndrome was the presenting symptom of calcium pyrophosphate dehydrate disease. All patients were treated with glucocorticoids as 0.5 mg/kg prednisone plus colchicine 0.5 mg bid resulting in dramatic improvement in both clinical (head/neck pain alleviated and cervical spinal mobility regained) and laboratory measures. CONCLUSIONS Crowned dens syndrome should be considered, and craniocervical junction imaged in the context of acute cervical or occipital pain with stiffness and elevated inflammation markers not only in patients previously diagnosed with calcium pyrophosphate dehydrate arthropathy but also in diverse clinical settings.Key Points• This report highlights that crowned dens syndrome should be considered in various clinical setting besides calcium pyrophosphate dehydrate (CPPD) arthropathy.• Vigilance to this syndrome allows rapid treatment and may spare the patient unnecessary invasive procedures (i.e., temporal artery biopsy or lumbar puncture).
Collapse
Affiliation(s)
- Abid Awisat
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel.
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel
| | - Amal Silawy
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel
| | - Nizar Jiries
- Internal medicine B, Bnai Zion Medical Center, 3339419, Haifa, Israel
| | - Shira Ginsberg
- Internal medicine B, Bnai Zion Medical Center, 3339419, Haifa, Israel
| | - Haya Hussein
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| |
Collapse
|
26
|
Crowned dens syndrome presenting as pyrexia of unknown origin (PUO). ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MÉDECINE INTERNE 2019; 57:266-269. [PMID: 31075087 DOI: 10.2478/rjim-2019-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Deposition of calcium pyrophosphate crystals in the cervical spine around the odontoid process may lead to neck pain and fever. This condition is called crowned dens syndrome (CDS). CASE REPORT An 89-year-old female presented with complaints of fever for one-month duration and recent onset neck pain. During her admission, she developed right knee pain with evidence of chondrocalcinosis on X-ray. Considering her clinical presentation in setting of pseudogout, she had a CT scan of her neck that revealed erosion of the dens and hyperdense soft tissue surrounding the odontoid process. Based on her clinical and radiologic presentation, she was diagnosed with crowned dens syndrome and started on NSAIDs. Unfortunately, she did not respond to NSAIDs and was switched to Colchicine, which resulted in immediate improvement in her symptoms. CONCLUSIONS We present this case to stress the importance of keeping crowned dens syndrome as one of the differentials in an elderly patient presenting with fever and neck pain.
Collapse
|
27
|
Moshrif A, Laredo JD, Bassiouni H, Abdelkareem M, Richette P, Rigon MR, Bardin T. Spinal involvement with calcium pyrophosphate deposition disease in an academic rheumatology center: A series of 37 patients. Semin Arthritis Rheum 2019; 48:1113-1126. [DOI: 10.1016/j.semarthrit.2018.10.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/17/2018] [Accepted: 10/09/2018] [Indexed: 11/25/2022]
|
28
|
Soma T, Asoda S, Kimura M, Munakata K, Miyashita H, Nakagawa T, Kawana H. Acute odontogenic infection combined with crowned dens syndrome: a case report. J Med Case Rep 2019; 13:143. [PMID: 31082330 PMCID: PMC6513512 DOI: 10.1186/s13256-019-2084-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 04/12/2019] [Indexed: 01/04/2023] Open
Abstract
Background Calcium pyrophosphate dihydrate crystal deposition disease is a condition in which calcium pyrophosphate dihydrate crystal is deposited in joint cartilage and ligaments. Calcium pyrophosphate dihydrate crystal deposition disease that involves calcification around the odontoid process of the second cervical vertebra is called crowned dens syndrome. Crowned dens syndrome is accompanied by fever in addition to acute and intense neck, posterior head, and temporal pain; thus, distinguishing crowned dens syndrome may be difficult in the presence of odontogenic infection. To the best of our knowledge, this is the first report describing a patient with crowned dens syndrome with coexisting odontogenic infection. Case presentation A 75-year-old Japanese woman was examined in the Emergency Department of this hospital due to a chief complaint of worsened buccal swelling on the left side. An odontogenic infection was considered, and she underwent her first examination. She presented with a body temperature of 37.4 °C, marked swelling and tenderness of her left lower eyelid through to her left cheek, and pain on the left temporal area. Blood tests revealed a leukocyte count of 6700/μL and a C-reactive protein level of 7.15 mg/dL. There was swelling and pain around the gingiva and acute purulent apical periodontitis of left maxillary second premolar. Cellulitis of the left cheek was diagnosed. After performing drainage of the pus, antibiotic treatment was initiated. Although her clinical symptoms improved, blood tests on day 9 of hospitalization revealed a leukocyte count of 6500/μL and a C-reactive protein level of 25.62 mg/dL, which were indicative of worsening symptoms. Computed tomography was performed to evaluate remote infection and images revealed a calcification around the odontoid process of her second cervical vertebra. When she was referred to the Orthopedic Surgery Department, pseudogout of the cervical spine was diagnosed. Subsequently, oral acetaminophen was initiated, and both her leukocyte count and C-reactive protein improved markedly. Conclusions In the presence of persistent fever and abnormally high leukocyte and C-reactive protein indicative of an inflammatory reaction, coexistence of pseudogout should be considered. In particular, when symptoms of temporal pain are present, the possibility of pseudogout of the cervical spine must be considered in the differential diagnosis.
Collapse
Affiliation(s)
- Tomoya Soma
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Seiji Asoda
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Moemi Kimura
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kanako Munakata
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hidetaka Miyashita
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taneaki Nakagawa
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiromasa Kawana
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|
29
|
Cooper R, Dudley J, Farmakiotis D. A Man With Headache, Fever, and Neck Stiffness. JAMA 2019; 321:1624-1625. [PMID: 30924841 DOI: 10.1001/jama.2019.1772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rachel Cooper
- Lifespan/Rhode Island Hospital, Providence
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - John Dudley
- Lifespan/Rhode Island Hospital, Providence
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dimitrios Farmakiotis
- Lifespan/Rhode Island Hospital, Providence
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
30
|
Slostad JA, Wild EM, Anderson CM, Ingram C. Intractable Neck Pain in a Patient With Newly Diagnosed AML: An Underrecognized Cause of a Treatable Syndrome. J Pain Symptom Manage 2019; 57:e3-e5. [PMID: 30316808 DOI: 10.1016/j.jpainsymman.2018.10.490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
MESH Headings
- Aged
- Atlanto-Axial Joint/diagnostic imaging
- Chondrocalcinosis/complications
- Chondrocalcinosis/diagnosis
- Chondrocalcinosis/drug therapy
- Diagnosis, Differential
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Male
- Neck Pain/diagnosis
- Neck Pain/drug therapy
- Neck Pain/etiology
- Pain, Intractable/diagnosis
- Pain, Intractable/drug therapy
- Pain, Intractable/etiology
Collapse
Affiliation(s)
- Jessica A Slostad
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Ellen M Wild
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Cory Ingram
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA; Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
31
|
Kim Y, Ko Y, Lee W, Shin Y, Noh C, Lee S, Park H. Acute neck pain due to crowned dens syndrome - A case report -. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.4.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yeojung Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Youngkwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Wonhyung Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yongsup Shin
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chan Noh
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seounghun Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyunwoo Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| |
Collapse
|
32
|
Suby JA, Novellino P, Da Peña G, Pandiani CD. Elongated odontoid process in late Holocene skeletal remains from B6 archaeological site, Mendoza, Argentina. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2018; 22:86-91. [PMID: 29906668 DOI: 10.1016/j.ijpp.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/26/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
The odontoid process of the axis can be affected by congenital or acquired pathologies. While abnormalities such as os odontoideum, agenesis, and fractures are reported in archaeological remains, the abnormality of an elongated length of the odontoid process has not been described in the paleopathological literature. The aim of this paper is to evaluate two individuals with elongated odontoid processes from a skeletal assemblage from the B6 archaeological site (Mendoza, Argentina), and to discuss the possible etiologies of the condition, with particular attention given to the relation to trauma and Crowned Dens Syndrome (CDS), a condition characterized by the ossification of ligaments of the odontoid process of the second cervical vertebra.
Collapse
Affiliation(s)
- J A Suby
- INCUAPA-CONICET, Argentina; Grupo de Investigación en Bioarquelogía (GIB), Facultad de Ciencias Sociales, Universidad Nacional del Centro de la Provincia de Buenos Aires, Unidad de Enseñanza Universitaria Quequén, 508 Street No. 881, ZIP 7631, Quequén, Buenos Aires, Argentina.
| | - P Novellino
- CONICET, Argentina; Museo de Ciencias Naturales y Antropológicas "J.C. Moyano", Mendoza, Av. Las Tipas y Prado Español s/N°, Parque Gral. San Martín, 5500, Mendoza, Argentina
| | - G Da Peña
- Museo de Ciencias Naturales y Antropológicas "J.C. Moyano", Mendoza, Av. Las Tipas y Prado Español s/N°, Parque Gral. San Martín, 5500, Mendoza, Argentina
| | - C D Pandiani
- Grupo de Investigación en Bioarquelogía (GIB), Facultad de Ciencias Sociales, Universidad Nacional del Centro de la Provincia de Buenos Aires, Unidad de Enseñanza Universitaria Quequén, 508 Street No. 881, ZIP 7631, Quequén, Buenos Aires, Argentina
| |
Collapse
|
33
|
When Calcium Pyrophosphate Deposition Disease Masquerades as Spinal Infection. J Clin Rheumatol 2018; 25:e118-e122. [PMID: 29667941 DOI: 10.1097/rhu.0000000000000727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
34
|
Goel P, Premnath N, Agrawal M, Gupta A. Unusual cause of neck pain. BMJ Case Rep 2018; 2018:bcr-2018-224183. [PMID: 29507035 DOI: 10.1136/bcr-2018-224183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pakhi Goel
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Naveen Premnath
- Internal Medicine, Icahn School of Medicine at Mount Sinai St Luke's-Roosevelt Hospital Center, New York, New York, USA
| | - Mugdha Agrawal
- Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Arjun Gupta
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
35
|
Gago R, Vilá S, Vélez-Rivera J, Vilá LM. Severe systemic inflammatory response syndrome immediately after spinal surgery in a patient with axial gout. BMJ Case Rep 2018; 2018:bcr-2017-222474. [PMID: 29367221 DOI: 10.1136/bcr-2017-222474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
We report a 55-year-old man with gouty arthritis who developed a 3-month history of low back pain, gradual lower extremities weakness and urinary incontinence. Lumbar MRI showed an exophytic lesion at L3-L4. Immediately after spinal decompression surgery, he developed fever, disorientation, polyarthritis, acute kidney injury and leucocytosis. He was treated with multiple antimicrobial agents for presumed spinal abscess but did not improve. Multiple body site cultures were negative. Aspiration of the sacroiliac joint revealed the presence of monosodium uric acid crystals. A diagnosis of acute gout was done, and he was treated with high-dose intravenous methylprednisolone and colchicine. Within 48 hours, he had a remarkable clinical improvement. At discharge, neurological and laboratory abnormalities had resolved. Awareness of risk factors for axial gout and a high degree of suspicion are important to establish a prompt diagnosis and treatment to prevent severe complications as seen in this case.
Collapse
Affiliation(s)
- Ricardo Gago
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Salvador Vilá
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Jonathan Vélez-Rivera
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Luis M Vilá
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| |
Collapse
|
36
|
Abstract
Crowned dens syndrome is a rare presentation of calcium pyrophosphate deposition disease. It is characterised by severe occipital pain and neck stiffness. Acute presentations are typically accompanied by fever and an inflammatory response and hence can be misdiagnosed as polymyalgia rheumatica or meningitis. Chronic relapsing presentations may be misdiagnosed as cervicogenic neck pain or occipital neuralgia. We present a patient who presented with a chronic relapsing form of crowned dens syndrome and discuss the epidemiology, typical presentation and management of this eminently treatable condition.
Collapse
|
37
|
Abstract
A 77-year-old man was admitted with posterior cervical pain, lumbago, a low-grade fever, and anorexia after bowel cleaning with polyethylene glycol for colonoscopy. Computed tomography of the neck showed calcification of the transverse ligament of the atlas. He was diagnosed with crowned dens syndrome (CDS). His condition improved following treatment with corticosteroids. This represents a rare case of CDS after endoscopy with polypectomy. We should consider CDS in the differential diagnosis of patients with unexplained fever and posterior cervical pain after bowel preparation for colonoscopy.
Collapse
Affiliation(s)
- Naoto Kohno
- Department of Internal Medicine, Seto Inland Sea Hospital, Japan
| | - Yoichiro Kobori
- Department of Internal Medicine, Seto Inland Sea Hospital, Japan
| | - Shuhei Yamaguchi
- Department of Neurology, Faculty of Medicine, Shimane University, Japan
| |
Collapse
|
38
|
Younis AAR. Crowned Dens Syndrome as a cause of acute neck pain: a Case Report and Review of the Literature. Mediterr J Rheumatol 2017; 28:101-105. [PMID: 32185265 PMCID: PMC7046027 DOI: 10.31138/mjr.28.2.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/22/2017] [Accepted: 06/03/2017] [Indexed: 11/09/2022] Open
Abstract
Crowned dens syndrome (CDS) is a rare clinical entity characterized by acute neck pain due to calcification around the odontoid process of the axis in “crown-like” configuration. Crystalline deposition in cervical vertebrae is less well known disease entity and only a limited number of cases have been reported to date. I here present a case of 79-year- old woman who developed acute severe neck pain and stiffness. Cervical computed tomography (CT) scan detected periodontoid calcification and a diagnosis of Crowned dens syndrome was made. Crowned dens syndrome should be considered in the differential diagnosis of acute neck pain, particularly in old age patients.
Collapse
|
39
|
Cammelli D, Vitiello G, Palterer B, Rosi A, Gabbani L. A case of acute febrile neck pain. Intern Emerg Med 2017; 12:551-552. [PMID: 27660158 DOI: 10.1007/s11739-016-1545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Daniele Cammelli
- Rheumatology Section, Immunoallergology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gianfranco Vitiello
- Experimental and Clinical Medicine Department, University of Florence, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Boaz Palterer
- Experimental and Clinical Medicine Department, University of Florence, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Rosi
- Experimental and Clinical Biomedical Sciences Department, University of Florence, Florence, Italy
| | - Luciano Gabbani
- Medical-Geriatric Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| |
Collapse
|
40
|
Takahashi T, Tamura M, Takasu T, Kamei S. Clinical and quantitative analysis of patients with crowned dens syndrome. J Neurol Sci 2017; 376:52-59. [DOI: 10.1016/j.jns.2017.02.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
|
41
|
Imamura T, Lotterman S, Glazer C. Elderly Male With Neck Stiffness and Fever. Ann Emerg Med 2017; 69:665-673. [DOI: 10.1016/j.annemergmed.2016.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Indexed: 11/28/2022]
|
42
|
Affiliation(s)
- Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Japan.
| | - Takahiro Ota
- Department of General Medicine, Chiba University Hospital, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Japan
| |
Collapse
|
43
|
Inoue A, Kohno K, Ninomiya S, Tomita H, Iwata S, Ohue S, Kamogawa K, Okamoto K, Fukumoto S, Ichikawa H, Onoue S, Ozaki S, Okuda B. Usefulness of cervical computed tomography and magnetic resonance imaging for rapid diagnosis of crowned dens syndrome: A case report and review of the literature. Int J Surg Case Rep 2016; 30:50-54. [PMID: 27902956 PMCID: PMC5133471 DOI: 10.1016/j.ijscr.2016.11.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/21/2016] [Indexed: 11/29/2022] Open
Abstract
We report a patient with crowned dens syndrome dramatically improved following treatment with nonsteroidal anti-inflammatory medication. This condition should be considered in the differential diagnosis of a possible etiology for fever, headache and cervical pain of unknown origin. The rapid diagnosis of crowned dense syndrome using CT and MRI can prevent invasive, expensive and useless investigations. It was very interesting that the soft tissue surrounding the odontoid process was hyperintense on MR T2-weighted imaging with fat suppression. This is the first report of making reference to MRI findings of crowned dens syndrome.
Introduction Crowned dens syndrome is a rare disease entity which radiologically shows calcification of the cruciform ligament around the odontoid process. We report a patient with crowned dens syndrome who improved dramatically in 5 days following treatment with oral nonsteroidal anti-inflammatory medication. Presentation of case A 61-year-old man was admitted to our hospital with a severe occipital headache and sudden onset of neck stiffness. Neurological examination on admission revealed a high fever and cervical rigidity. Laboratory examination revealed a markedly elevated white blood cell count and C-reactive protein level, but cerebrospinal fluid studies revealed only a slight abnormality. A cervical computed tomography scan and its three-dimensional reconstruction detected a remarkable crown-like calcification surrounding the odontoid process. Cervical magnetic resonance imaging did not demonstrate strong direct compression of the cervical cord; however, the soft tissue surrounding the odontoid process was hyperintense on T2-weighted imaging with fat suppression. Based on the radiological findings, the patient was diagnosed with crowned dens syndrome and was immediately treated with non-steroidal anti-inflammatory drugs. The patient’s condition drastically improved within 5 days. Discussion It was very interesting that the soft tissue surrounding the odontoid process was hyperintense on magnetic resonance T2-weighted imaging with fat suppression, and the signal change disappeared 2 weeks after the administration of oral non-steroidal anti-inflammatory drugs. We think that magnetic resonance imaging is useful for proving inflammation in patients with crowned dens syndrome. Conclusion This is the first report making reference to the magnetic resonance imaging findings of crowned dens syndrome.
Collapse
Affiliation(s)
- Akihiro Inoue
- Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan.
| | - Kanehisa Kohno
- Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan
| | - Satoko Ninomiya
- Departments of Neurology, Ehime Prefectural Central Hospital, Japan
| | - Hitomi Tomita
- Departments of Neurology, Ehime Prefectural Central Hospital, Japan
| | - Shinji Iwata
- Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan
| | - Shiro Ohue
- Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan
| | - Kenji Kamogawa
- Departments of Neurology, Ehime Prefectural Central Hospital, Japan
| | - Kensho Okamoto
- Departments of Neurology, Ehime Prefectural Central Hospital, Japan
| | - Shinya Fukumoto
- Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan
| | - Haruhisa Ichikawa
- Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan
| | - Shinji Onoue
- Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan
| | - Saya Ozaki
- Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan
| | - Bungo Okuda
- Departments of Neurology, Ehime Prefectural Central Hospital, Japan
| |
Collapse
|
44
|
Nakano H, Nakahara K, Michikawa Y, Suetani K, Morita R, Matsumoto N, Itoh F. Crowned dens syndrome developed after an endoscopic retrograde cholangiopancreatography procedure. World J Gastroenterol 2016; 22:8849-8852. [PMID: 27818601 PMCID: PMC5075560 DOI: 10.3748/wjg.v22.i39.8849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/26/2016] [Accepted: 07/21/2016] [Indexed: 02/06/2023] Open
Abstract
We present a unique case of crowned dens syndrome (CDS) that developed after endoscopic retrograde cholangiopancreatography (ERCP) in a patient who presented with fever and neck pain. Administration of non-steroidal anti-inflammatory drugs was extremely effective for relieving fever and neck pain, and in the improvement of inflammatory markers. To the best of our knowledge, this is the first case report of CDS caused by an ERCP procedure. In a patient with fever and neck pain after an ERCP procedure, CDS should be considered in the differential diagnosis.
Collapse
|
45
|
Magnetic Resonance Imaging and Computed Tomography in the Evaluation of Crowned Dens Syndrome Secondary to Calcium Pyrophosphate Dihydrate. J Clin Rheumatol 2016; 21:368-9. [PMID: 26398465 DOI: 10.1097/rhu.0000000000000315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Jain N, Verma R, Garga UC, Baruah BP, Jain SK, Bhaskar SN. CT and MR imaging of odontoid abnormalities: A pictorial review. Indian J Radiol Imaging 2016; 26:108-19. [PMID: 27081234 PMCID: PMC4813060 DOI: 10.4103/0971-3026.178358] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Odontoid process is the central pillar of the craniovertebral junction. Imaging of this small structure continues to be a challenge for the radiologists due to complex bony and ligamentous anatomy. A wide range of developmental and acquired abnormalities of odontoid have been identified. Their accurate radiologic evaluation is important as different lesions have markedly different clinical course, patient management, and prognosis. This article seeks to provide knowledge for interpreting appearances of odontoid on computed tomography (CT) and magnetic resonance imaging (MRI) with respect to various disease processes, along with providing a quick review of the embryology and relevant anatomy.
Collapse
Affiliation(s)
- Nishchint Jain
- Department of Radio-Diagnosis, Postgraduate Institute of Medical Education and Research (PGIMER and RML), Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ritu Verma
- Department of Radio-Diagnosis, Postgraduate Institute of Medical Education and Research (PGIMER and RML), Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Umesh C Garga
- Department of Radio-Diagnosis, Postgraduate Institute of Medical Education and Research (PGIMER and RML), Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Barinder P Baruah
- Department of Radio-Diagnosis, Postgraduate Institute of Medical Education and Research (PGIMER and RML), Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sachin K Jain
- Department of Medicine, Postgraduate Institute of Medical Education and Research (PGIMER and RML), Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Surya N Bhaskar
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER and RML), Dr. Ram Manohar Lohia Hospital, New Delhi, India
| |
Collapse
|
47
|
Tajima K, Ueda T, Ueno K, Shimizu C, Yoshizawa J, Hori S. Crowned dens syndrome: reports of six cases and review of the literature. Acute Med Surg 2015; 3:155-158. [PMID: 29123771 DOI: 10.1002/ams2.147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/02/2015] [Indexed: 11/07/2022] Open
Abstract
Case We have reported six cases of Crowned dens syndrome (CDS) diagnosed by computed tomography (CT). Presenting cases were three male and three female, aged from 45 to 89 (averaged in 72). Outcome All cases showed calcification around the dens of axis in CTs. Neck pain in all cases relieved within at least 10 days, treated by non-steroidal anti-inflammatory drugs (NSAIDs) in five cases, and one by acetaminophens. Conclusion Bouvet et al. first reported CDS in 1985, as acute pseudogout of the neck, which causes neck pain. CDS is a radioclinical syndrome defined by the radiographic calcifications in a crown-like configuration around the odontoid process, accompanied clinically by acute neck pain, often with neck stiffness, fevers and raised inflammatory markers. CDS is thought to be a rare condition; however, it is frequently misdiagnosed. CDS is an important differential diagnosis in patients presenting with acute neck pain.
Collapse
Affiliation(s)
- Kosuke Tajima
- Department of Emergency and Critical Care Medicine School of Medicine Keio University Tokyo Japan
| | - Tomoko Ueda
- Department of Emergency and Critical Care Medicine School of Medicine Keio University Tokyo Japan
| | - Koichi Ueno
- Department of Emergency and Critical Care Medicine School of Medicine Keio University Tokyo Japan
| | - Chikako Shimizu
- Department of Emergency and Critical Care Medicine School of Medicine Keio University Tokyo Japan
| | - Joe Yoshizawa
- Department of Emergency and Critical Care Medicine School of Medicine Keio University Tokyo Japan
| | - Shingo Hori
- Department of Emergency and Critical Care Medicine School of Medicine Keio University Tokyo Japan
| |
Collapse
|
48
|
Oka A, Okazaki K, Takeno A, Kumanomido S, Kusunoki R, Sato S, Ishihara S, Kinoshita Y, Nishina M. Crowned Dens Syndrome: Report of Three Cases and a Review of the Literature. J Emerg Med 2015; 49:e9-e13. [PMID: 25910825 DOI: 10.1016/j.jemermed.2015.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/14/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with crowned dens syndrome (CDS), which is pseudogout of the atlantoaxial junction induced by "crown-like" calcifications around the dens, present with symptoms of severe neck pain, rigidity, and high fever. CDS patients are often misdiagnosed as having meningitis or polymyalgia rheumatica, leading to potentially unnecessary invasive procedures for diagnosis and treatment. CASE REPORT We report 3 patients with CDS who had characteristic findings on computed tomography (CT), all of whom quickly recovered with nonsteroidal antiinflammatory drug (NSAID) administration. In addition, we reviewed 72 published cases, including our patients. CDS typically occurs in elderly people (mean age 71.4 years). Common symptoms include neck pain (100%), neck rigidity (98%), and fever (80.4%), and most show elevated inflammatory markers (88.3%) on serum laboratory tests. Neck pain on rotation is a characteristic and helpful symptom in the diagnosis. The most useful modality is CT (97.1%), showing linear calcium deposits around the dens, mostly in the transverse ligament of atlas (TLA). CT number is especially helpful to distinguish a normal TLA (35-110 HU) from a calcified one (202-258 HU) in our cases. The most effective treatment is NSAID administration (85%), which usually leads to marked resolution of symptoms within days or weeks. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Due to acute and severe symptoms, CDS patients often present to an emergency department. To avoid unnecessary invasive procedures for diagnosis and treatment, CDS should be considered in the differential diagnosis of febrile neck pain.
Collapse
Affiliation(s)
- Akihiko Oka
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Koichi Okazaki
- Fourth Department of Internal Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Ayumu Takeno
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Satoshi Kumanomido
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Ryusaku Kusunoki
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Shuichi Sato
- Second Department of Internal Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Shunji Ishihara
- Second Department of Internal Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Yoshikazu Kinoshita
- Second Department of Internal Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Masayoshi Nishina
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| |
Collapse
|
49
|
Yamada T, Saitoh T, Hozumi H, Takahashi Y, Nozawa M, Mochizuki T, Yoshino A. Crowned dens syndrome. Acute Med Surg 2015; 2:273. [PMID: 29123739 DOI: 10.1002/ams2.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Taiki Yamada
- Department of Emergency and Disaster Medicine Hamamatsu University School of Medicine Hamamatsu Japan
| | - Takeji Saitoh
- Department of Emergency and Disaster Medicine Hamamatsu University School of Medicine Hamamatsu Japan
| | - Hironao Hozumi
- Department of Emergency and Disaster Medicine Hamamatsu University School of Medicine Hamamatsu Japan
| | - Yoshiaki Takahashi
- Department of Emergency and Disaster Medicine Hamamatsu University School of Medicine Hamamatsu Japan
| | - Masashi Nozawa
- Department of Emergency and Disaster Medicine Hamamatsu University School of Medicine Hamamatsu Japan
| | - Toshiaki Mochizuki
- Department of Emergency and Disaster Medicine Hamamatsu University School of Medicine Hamamatsu Japan
| | - Atsuto Yoshino
- Department of Emergency and Disaster Medicine Hamamatsu University School of Medicine Hamamatsu Japan
| |
Collapse
|
50
|
Koda R, Tsuchida Y, Yoshizawa K, Suzuki K, Kasai A, Takeda T, Kazama JJ, Narita I, Yoshida K. Crowned Dens Syndrome as an Initial Manifestation of Crystalline Deposition Disease. Intern Med 2015; 54:2405-8. [PMID: 26370870 DOI: 10.2169/internalmedicine.54.4571] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 88-year-old woman presented with fever and acute posterior neck pain. A CT scan revealed calcification of the transverse ligament and crown-like calcification around the odontoid process. According to the clinical and radiological findings, she was diagnosed with crowned dens syndrome (CDS). Her symptoms drastically improved following treatment with oral nonsteroidal anti-inflammatory medication. An X-ray of her wrist, elbow, shoulder and knee joints showed asymptomatic calcium deposits, suggesting underlying crystalline deposition disease. CDS may occur as the initial presentation of crystalline deposition disease. The measurement of procalcitonin and an X-ray survey of the major joints may be helpful for the diagnosis of CDS.
Collapse
Affiliation(s)
- Ryo Koda
- Niigata Prefectural Muikamachi Hospital, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|