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

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

“…As illustrated in our patients and in those reported previously (7,8,14), crowned dens syndrome can mimic and lead to misdiagnosis of meningitis, epidural abscess, rheumatoid arthritis, polymyalgia rheumatica, giant cell arthritis, cervical spondylitis, or metastatic bone tumors. However, based on our experience in 14 patients, the distribution and character of the pain (i.e., mostly from the suboccipital region to the posterior part of the neck on both sides without specific points of tenderness and abnormal superficial sensation) and restricted neck motion, particularly in rotation, are strongly suggestive of crowned dens syndrome.…”

“…However, based on our experience in 14 patients, the distribution and character of the pain (i.e., mostly from the suboccipital region to the posterior part of the neck on both sides without specific points of tenderness and abnormal superficial sensation) and restricted neck motion, particularly in rotation, are strongly suggestive of crowned dens syndrome. As described previously (7,8,14,15), CT imaging of the cervical spine was superior to MRI in confirming CPPD crystal deposition in our patients, especially when calcifications were small. Ideally, CT should be analyzed multidirectionally using reconstruction images, as the axial view is useful for detecting calcification of the transverse ligament, ligamenta flava, and alar ligament; the coronal view is useful for detecting calcification of the apical ligament; and the sagittal view is useful for detecting calcification of the longitudinal fibres of the cruciate ligament (Figs.…”

“…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).…”

Incidence, Age and Gender of Subjects With the Calcium Pyrophosphate Deposition Around the Dens, and Clinical Characteristics of Patients With Crowned Dens Syndrome

“…According to our Pubmed search (reports written in English), the mean age in patients with CDS was 78.1 years old (11 males and 11 females), supporting a significant association between CDS and old age [2,4,5,7,8,[11][12][13][14][15][16][17][18][19][20][21][22][23].…”

“…Clinical symptoms are due to pseudogout of the atlantoaxial junction induced by calcifications around the dens [1]. The computed tomography (CT) is the gold standard in identifying CDS, as it is able to depict the shape and site of calcification, and CT shows radiopaque densities surrounding the top and sides of the odontoid process in a crown-like distribution [1][2][3][4]. Characteristic CT findings have been reported [5][6][7][8].…”