An Uncommon Presentation of Crowned Dens Syndrome Without Systemic Inflammation

TL;DR

This paper presents a rare case of Crowned Dens Syndrome in an elderly man without systemic inflammation, highlighting the importance of early diagnosis and conservative treatment.

Contribution

The case demonstrates CDS without systemic inflammation, emphasizing the role of CT imaging for accurate diagnosis.

Findings

CT imaging revealed calcifications and erosive changes consistent with CDS in a 74-year-old male.

Conservative treatment with NSAIDs and physical therapy led to significant symptom improvement.

The case underscores the need for awareness of CDS to avoid unnecessary interventions.

Abstract

Crowned Dens Syndrome (CDS) is a rare but important consideration in the differential diagnosis of cervical spine pain in older adults. CDS is characterized by calcium pyrophosphate dihydrate (CPPD) crystal deposition around the odontoid process, often leading to symptoms that overlap with more common conditions such as rheumatoid arthritis (RA), meningitis, or cervical spondylosis. We report the case of a 74-year-old male with chronic neck pain and restricted cervical range of motion. Advanced imaging revealed characteristic calcifications surrounding the odontoid process, pannus formation, and erosive changes at the C1-C2 articulation, consistent with CDS. Clinical evaluation supported a diagnosis of CPPD-related CDS. The patient was successfully managed conservatively with nonsteroidal anti-inflammatory drugs and physical therapy, with notable symptomatic improvement over time. This case reinforces the utility of CT imaging in diagnosing CDS and differentiating it from other inflammatory or degenerative cervical conditions. Awareness of CDS and a high index of suspicion are essential for early diagnosis, appropriate treatment, and avoidance of unnecessary interventions. Conservative management remains effective in most cases; however, further studies are necessary to evaluate alternative therapies for refractory presentations.

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