# Spontaneous Cervical Epidural Hematoma Mimicking Crowned Dens Syndrome: A Case Report

## TL;DR

An 85-year-old man with neck pain and calcifications was found to have a rare spinal hematoma, showing the need for careful diagnosis beyond initial symptoms.

## Contribution

Highlights a rare case where spontaneous cervical epidural hematoma was misdiagnosed as crowned dens syndrome, emphasizing the importance of thorough evaluation.

## Key findings

- A patient on anticoagulant therapy presented with calcifications and neck pain, later diagnosed with a spinal hematoma.
- Conservative management led to full recovery, emphasizing the importance of MRI in such cases.
- Odontoid calcifications on CT should not rule out other serious pathologies like epidural hematoma.

## Abstract

Crowned dens syndrome (CDS) typically manifests as acute neck pain accompanied by calcifications around the odontoid process. However, such findings may obscure more serious underlying pathologies. We report a case of an 85-year-old man on edoxaban who presented with acute neck pain and atlantoaxial calcifications on computed tomography (CT), initially suggestive of CDS. Subsequent mild neurological deficits prompted cervical magnetic resonance imaging (MRI), which revealed a spontaneous cervical epidural hematoma (SCEH) extending from C2 to C4. The patient was managed conservatively and achieved complete recovery. This case highlights the importance of considering SCEH in the differential diagnosis of severe neck pain, even when odontoid calcification is observed on CT, especially in patients receiving anticoagulant therapy. Thorough clinical evaluation and close follow-up are essential for timely diagnosis and management.