Crowned Dens Syndrome: Report of Three Cases and a Review of the Literature

Oka, Akihiko; Okazaki, Kosuke; Takeno, Ayumu; Kumanomido, Satoshi; Kusunoki, Ryusaku; Sato, Shuichi; Ishihara, Shunji; Kinoshita, Yoshikazu; Nishina, Masayoshi

doi:10.1016/j.jemermed.2015.02.005

Cited by 40 publications

(69 citation statements)

References 35 publications

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“…However, nine subjects with CDS in our study II included five females and four males, which did not agree with the previous two studies [10,24]. Further, according to case reports accumulated by our Pubmed search, 11 of 22 cases with CDS were women, challenging a female predominance in CDS [2,4,5,7,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. To confirm a female predominance in CDS, further studies, preferably with a greater number of CDS subjects, are needed.…”

Section: Yoshikawa Et Alcontrasting

confidence: 68%

“…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].…”

Section: Yoshikawa Et Almentioning

confidence: 65%

“…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]. The diagnosis of CDS may be based on clinical symptoms such as neck pain, neck stiffness and fever, and the calcifications surrounding the top and sides of the odontoid process which are detected by CT, and increased levels of inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein (CRP) [1,6,9,10].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2016

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Section: Yoshikawa Et Alcontrasting

confidence: 68%

Section: Yoshikawa Et Almentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…CPPD can also occur in the spine, classically presenting as the crowned dens syndrome. 65,66 Patients with crowned dens syndrome present with a classic triad of neck pain, neck stiffness, and fever. CT reveals linear calcifications around the dens, usually in the transverse ligament of the atlas and in the synovial membrane of the articular capsule or the cruciate or alar ligaments.…”

Section: Calcium Pyrophosphate Deposition Diseasementioning

confidence: 99%

Advanced Imaging in the Diagnosis of Gout and Other Crystal Arthropathies

Teh

McQueen

Eshed³

et al. 2018

Semin Musculoskelet Radiol

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In recent years significant advances have been made in imaging techniques. Dual-energy computed tomography has revolutionized the ability to detect and quantify gout. The key ultrasound features of gout have been defined. Magnetic resonance imaging is an excellent modality for demonstrating the extent and severity of crystal arthropathies, but the findings may be nonspecific. This article summarizes the use of advanced imaging techniques in the diagnosis and assessment of gout and other crystal arthropathies.

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“…Myelopathy is an extremely rare complication of CDS [3]. Therapy of CDS is based primarily on nonsteroidal anti-inflammatory drugs (NSAIDs); corticosteroids and colchicine seem to be effective in severe or recurrent cases [1,4]. Some case series support the effectiveness of interleukin 1-beta inhibitors in patients with acute arthritis due to calcium pyrophosphate deposition [5].…”

mentioning

confidence: 99%

A case of acute febrile neck pain

et al. 2016

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An 80-year-old woman presented with a 2-month history of worsening pain of her neck, associated with a 3-week history of hypomobility, and a progressive hyposthenia of the upper and the lower limbs. For this reason, she was admitted to our department. The past history was positive for osteoarthritis and hypertension. The patient was febrile (up to 39°C), and she complained about sharp severe neck pain causing rigidity and preventing neck movement. The physical examination revealed plegia of both upper limbs, hyperreflexia, and paresis of lower limbs and bilateral positive Babinski signs. Blood laboratory tests showed highly elevated acute phase proteins. Computed tomography (CT) of the neck showed atlanto-axial diffused and crown-like calcifications around the dens, which appeared largely eroded, but were kept in place by calcifications. No signs of atlanto-occipital and atlanto-axial subluxation were present (Fig. 1a, b). Numerous nodular-shaped calcium depositions were also present along the ligamenta flava, around the glenohumeral joints, the sternum, the pelvis, and within the small articulations of her hands (not shown). A diagnosis of severe systemic chondrocalcinosis with crowned dens syndrome (CDS) was made. Because of the clinical suggestion of medullar compression, she underwent magnetic resonance of the cervical tract, which showed anterior compression of the spinal cord by the pannus determined by the calcium deposition associated with hypersignal intensity on T2-weighted images at C1-C2 level (Fig. 1c). Bolus corticosteroids (methylprednisolone 500 mg/daily) and oral colchicine (1 mg/daily) were administered for 1 week without any clinical improvement.

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Crowned Dens Syndrome: Report of Three Cases and a Review of the Literature

Cited by 40 publications

References 35 publications

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

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

Advanced Imaging in the Diagnosis of Gout and Other Crystal Arthropathies

A case of acute febrile neck pain

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