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[Crowned dens syndrome: three new cases].

A Aouba¹, O Lidove, P Gepner

¹Service de médecine interne, hôpital Foch, Suresnes, France. achile.aouba@wanadoo.fr

La Revue De Medecine Interne

|March 5, 2003

Summary

Crowned dens syndrome, caused by microcrystalline deposits, can mimic meningitis or spondylitis. Early diagnosis via CT scans and prompt anti-inflammatory treatment can significantly improve patient outcomes.

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Area of Science:

Rheumatology
Neurology
Radiology

Background:

Crowned dens syndrome involves microcrystalline deposition (hydroxyapatite or calcium pyrophosphate) in the retro-odontoidal ligament of the atlas.
This condition is frequently misdiagnosed as meningitis or spondylitis, delaying appropriate treatment.

Observation:

Three cases diagnosed between 1996-1999 presented with cervicalgia, headaches, and fever.
Clinical examination revealed meningism and inflammatory syndrome; cerebrospinal fluid analysis was normal in two patients.
Diagnosis was confirmed by C1/C2 CT scans in two cases and wrist chondrocalcinosis in one.

Findings:

A potential association between crowned dens syndrome and genetic hemochromatosis was observed.
Non-steroidal anti-inflammatory drug treatment led to rapid symptom resolution.

Implications:

Crowned dens syndrome is an under-recognized condition that can present with diverse symptoms, mimicking other serious illnesses.
Increased awareness and utilization of advanced imaging techniques like CT are crucial for accurate and timely diagnosis.