Early diagnosis and treatment of crowned dens syndrome: a report of two cases

Abstract

We report two patients with crowned dens syndrome (CDS) who improved dramatically following treatment with oral nonsteroidal anti-inflammatory drugs (NSAIDs). Case1: A 70-year-old woman presented with acute neck pain, neck stiffness and fever for five days. Blood test revealed elevated WBC and CRP. Computed tomography (CT) of the cervical spine (C-spine) showed calcium deposits encircling the dens. The patient was treated with oral NSAIDs and the symptoms improved in a week. Case 2: An 84-year-old woman underwent the lumbar peritoneal shunt for idiopathic normal pressure hydrocephalus. Four days after the operation, the patient complained of fever, headache, nausea, neck pain and stiffness. Blood test revealed elevated inflammatory biomarkers and CT of the C-spine showed the peri-odontoid calcium deposits. Her symptoms improved with use of NSAIDs in a week. CDS should be considered in the differential diagnosis in patients who present with acute neck pain.