Answer:
Crowned Dens Syndrome
Findings:
CT revealed calcific deposits around the dens in the transverse and alar ligaments, and in the anterior atlantooccipital membrane. CT also shows horseshoe- or crown-like calcification surrounding the odontoid process in Coronal Sections . MRI TI Sag shows hypointense deposits superior and posterior to dens.
Discussion:
The crowned dens syndrome (CDS) is an under recognized radioclinical entity characterized by the association of radiological calcifications of the cruciform ligament around the odontoid process and periodic acute cervicooccipital pains and may be associated with fever, neck stiffness and biological inflammatory syndrome. It is important to recognize this entity radiologically since atypical form can mimic giant cell arteritis, polymyalgia rheumatica, meningitis or discitis. CT is the gold standard to identify crowned dens syndrome, since it can depict the shape and site of calcification and any bone erosions. Radiography of other joints (wrist, knee, pubic symphysis) is used to ascertain whether the disease is due to calcium pyrophosphate dihydrate or hydroxyapatite crystals and must be suggested for routine patient management. MRI is done to evaluate neurological complications. Treatment with NSAIDS like ketoprofen usually leads to dramatic clinical improvement in a couple of days with normalization of laboratory parameters in 10–14 days.
Reference : Rheumatology 2004;43:1508–1512 Crowned dens syndrome misdiagnosed as polymyalgia rheumatica, giant cell arteritis, meningitis or spondylitis: an analysis of eight cases A. Aouba et al
Contributed By: Dr.S. Babu Peter
Associate Professor, Barnard Institute of Radiology, Chennai, India
Consultant Radiologist, Aarthi Scans, Alwarpet, Chennai, India
Crowned Dens Syndrome
Findings:
CT revealed calcific deposits around the dens in the transverse and alar ligaments, and in the anterior atlantooccipital membrane. CT also shows horseshoe- or crown-like calcification surrounding the odontoid process in Coronal Sections . MRI TI Sag shows hypointense deposits superior and posterior to dens.
Discussion:
The crowned dens syndrome (CDS) is an under recognized radioclinical entity characterized by the association of radiological calcifications of the cruciform ligament around the odontoid process and periodic acute cervicooccipital pains and may be associated with fever, neck stiffness and biological inflammatory syndrome. It is important to recognize this entity radiologically since atypical form can mimic giant cell arteritis, polymyalgia rheumatica, meningitis or discitis. CT is the gold standard to identify crowned dens syndrome, since it can depict the shape and site of calcification and any bone erosions. Radiography of other joints (wrist, knee, pubic symphysis) is used to ascertain whether the disease is due to calcium pyrophosphate dihydrate or hydroxyapatite crystals and must be suggested for routine patient management. MRI is done to evaluate neurological complications. Treatment with NSAIDS like ketoprofen usually leads to dramatic clinical improvement in a couple of days with normalization of laboratory parameters in 10–14 days.
Reference : Rheumatology 2004;43:1508–1512 Crowned dens syndrome misdiagnosed as polymyalgia rheumatica, giant cell arteritis, meningitis or spondylitis: an analysis of eight cases A. Aouba et al
Contributed By: Dr.S. Babu Peter
Associate Professor, Barnard Institute of Radiology, Chennai, India
Consultant Radiologist, Aarthi Scans, Alwarpet, Chennai, India