Acute neck pain due to calcifications surrounding the odontoid process: The crowned dens syndrome

The crowned dens syndrome as a cause of neck pain: Report of two new cases and review of the literature

“…In most of the other cases, the diagnosis of CPPD was supported by radiographic evidence of chondrocalcinosis of appendicular joints, most commonly shoulders, hips, and knees. Four cases were further supported by arthrocentesis and demonstration of CPPD or hydroxyapatite crystals (11). The mainstay of medical treatment of neck pain due to CDS has been nonsteroidal antiinflammatory drugs with generally prompt resolution of symptoms, though up to 2 months of therapy was necessary in 4 cases (11,14), including one of our patients.…”

“…As suggested by Bouvet et al (11), the radiographic localization of calcium deposition in CDS suggests involvement of the cruciform ligament, a ligament located posterior to the odontoid in the form of a cross, with the horizontal bar formed by the transverse ligament of the atlas and the vertical bars formed by the superior and inferior longitudinal fascicles. It is quite possible that some of the patients in the case series describing CPPD deposition of the transverse ligament of the atlas and the ligamentum flavum represent cases of CDS as well.…”

“…CDS was described by Bouvet et al in 1985 as neck pain caused by deposition of hydroxyapatite or CPPD crystals in the cervical spine and appearing radiographically as radioopaque densities surrounding the top and sides of the odontoid process in a crown-or halo-like distribution (11). In addition to the 4 cases described by Bouvet and the 2 cases presented in this series, we identified 11 additional cases in the English literature via Medline and PubMed database searches and citations from relevant articles (11)(12)(13)(14)(15). All patients presented with neck pain though duration of symptoms ranged from acute to several years.…”

“…In summary, CDS is a clinical-radiologic entity consisting of neck pain and cervical spine calcium crystal deposition with CT scan demonstrating densities surrounding the top and sides of the odontoid process in a crown-or halo-like distribution (11). This syndrome, along with calcium crystal deposition of the cervical spine in general (including the transverse ligament of the atlas and ligamentum flavum) can mimic meningitis (32), osteomyelitis (33,34), degenerative cervical spine disease, ankylosing spondylitis (35), gout (36,37), rheumatoid arthritis (38), temporal arteritis, metastatic bone disease (39,40), and spinal tumors (41).…”

CPPD crystal deposition disease of the cervical spine: A common cause of acute neck pain encountered in the neurology department

“…However, CPPD crystal deposition on the cervical spine is less well known and only a limited number of cases of this condition have been reported to date (6)(7)(8)(9)(10)(11)(12)(13)(14).…”