No abstract

Osteoporosis and fractures are extremely common in the multiple sclerosis (MS) population, especially in those women with MS who are postmenopausal and not on hormone replacement therapy (HRT). There is evidence of significantly increased fracture risk in MS patients who have been on steroids, although this appears to be due to increased falls in addition to osteoporosis. Additionally, evidence has indicated that high-dose pulse methylprednisolone has little effect on osteoporosis, but decreased mobility is a very significant factor in decreased bone density. Osteoporosis in MS results in part from causes present in the general population, but is significantly aggravated by immobility and probably by other drugs used to treat MS and its complications, including drugs known to increase bone loss (eg, diphenylhydantoin). Fractures in MS are a particularly serious problem in that the resulting immobility causes deconditioning. A fracture—any fracture—is a much more serious problem in those with MS than in the general population. For example, use of narcotics for pain control in the MS patient with a fracture can convert constipation to obstipation or even bowel obstruction. Deconditioning resulting from injury-related immobility recovers much more slowly than in healthy individuals, and may never return to the preinjury level. Often a fracture converts an individual from being ambulatory to permanent wheelchair status. With preventive measures and moderately effective therapy available, it is important to identify those at risk and initiate appropriate treatment.

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.