Acute Calcific Prevertebral Tendonitis Mimicking Tension-Type Headache

Abstract

A 74-year-old woman was admitted to our hospital due to severe nuchal pain and occipitalgia. Neurological examination found neck stiffness but no throat pain or dysphagia. Blood examination showed slight elevation of white blood cell count, but C-reactive protein level was normal. Cerebrospinal fluid examination found no abnormalities. Computed tomography (CT) and magnetic resonance (MR) imaging demonstrated no abnormalities in the brain. Cervical CT showed a small calcification in front of the C1 body. Cervical T 2 -weighted MR imaging showed a high intensity area in front of the upper cervical vertebral body from C1 to C4, suggesting inflammation of the longus colli muscles. We diagnosed acute calcific prevertebral tendonitis. She was administered nonsteroidal anti-inflammatory drugs. Her symptoms gradually improved and she was discharged without neurological deficit 8 days after admission. It is important to be aware of the possibility of this rare disease in a patient with severe occipitalgia but no sign of intracerebral lesion.

Two rare diseases, acute calcific retropharyngeal tendinitis, and crowned dens syndrome, mimicking meningitis: A case report

“…In terms of laboratory data, white blood cell counts range from normal to mild leukocytosis, and levels of CRP and ESR are increased in most cases (8,(13)(14)(15). As in our case, CSF findings are typically within normal limits (16). Cervical CT is useful for diagnosing acute calcific retropharyngeal tendinitis, showing increased soft-tissue shadows ventral to the cervical spine and calcification anterior to the C1/2 vertebra.…”

“…Therefore, both crowned dens syndrome and acute calcific retropharyngeal tendinitis involve the C1/2 joint. When encountering a patient with neck pain and severe limitation of neck movement, clinicians should consider acute calcific retropharyngeal tendinitis and crowned dens syndrome as possibilities and perform cervical CT. Second, altered consciousness is common in cases of meningitis (6) but not in cases of acute calcific retropharyngeal tendinitis or crowned dens syndrome (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). When encountering a patient with neck pain and altered consciousness, clinicians should consider the possibility of meningitis and perform a CSF examination.…”

Case reports about an overlooked cause of neck pain

“…[ 10 , 12 – 15 ] The sex incidence is equal. [ 15 , 16 ] The common presenting symptoms are acute to subacute onset of neck pain and stiffness, and it is often associated with odynophagia. The odynophagia is due to the close proximity of the retropharyngeal space to the pharyngeal constrictors.…”

“…[ 13 ] Clinically, many cases may have been treated as tension-type headache or some other disorder. [ 16 ] To exclude the other causes of acute neck pain, such as traumatic injury, retropharyngeal abscess, infectious spondylitis, or meningitis, the diagnostic imaging work-up should be performed.…”

Acute Prevertebral Calcific Tendinitis

“…All of her symptoms gradually improved with the administration of non-steroidal anti-inflammatory medication and local rest using a neck collar. APCT is a rare disease accompanied by severe neck pain and a fever ( 1 , 2 ). It is important for physicians to be aware of its MRI and CT findings to avoid performing any unnecessary medical and surgical intervention.…”