Скачать или смотреть Crowned Dens Syndrome; cause of acute neck pain, especially in older adults

Crowned Dens Syndrome (CDS) is a rare but striking cause of acute neck pain, typically seen in older adults. It’s named for the crown-like calcifications that form around the odontoid process (the “dens”) of the second cervical vertebra (C2), visible on CT scans.

💎 What Causes It?
CDS is usually triggered by crystal deposition, most commonly:

Calcium pyrophosphate dihydrate (CPPD) — associated with pseudogout

Hydroxyapatite crystals — linked to calcific tendinitis

These crystals deposit in the periodontoid ligaments (especially the transverse and alar ligaments), causing inflammation and pain.

🔍 Symptoms
Sudden, severe neck pain—often at the base of the skull

Neck stiffness and limited mobility

Fever and elevated inflammatory markers (CRP, ESR)

Occasionally neurological symptoms if spinal cord compression occurs

It’s often misdiagnosed as:

Meningitis

Polymyalgia rheumatica

Giant cell arteritis

Cervical spondylitis

🧪 Diagnosis
CT scan is the gold standard: shows crown-like calcifications around the dens

MRI: useful for assessing inflammation or spinal cord involvement

Blood tests: elevated ESR/CRP, but no infection

🛠️ Treatment
NSAIDs or corticosteroids to reduce inflammation

Physical therapy once acute symptoms subside

Surgery is rarely needed unless there's spinal cord compression

Most cases resolve within days to weeks, though some may linger for months

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