Painful neck on rotation: diagnostic significance for crowned dens syndrome
From: J Neurol. 2009 Aug 30
The crowned dens syndrome is a clinicoradiological entity defined as acute neck pain due to deposition of crystals surrounding the odontoid process. Crystal deposition may occur without symptoms or exhibit myelopathy by compressing the spinal cord. Neck pain on lateral rotation has been described in the previous papers for crowned dens syndrome. We tested the validity of “painful neck on rotation” as a potential diagnostic tool to differentiate crowned dens syndrome from meningeal irritation. Patients 1 and 2 were relatively young females and showed acute cervico-occipital pain, with marked limitation on neck rotation. Patient 2 was suspected to have neck strain, since there was no fever and no elevated CRP. In contrast, patient 3 was an older female and showed headache and limitation of neck rotation. Cerebrospinal fluid was normal in spite of inflammatory reaction on laboratory markers. All three patients showed absence of or only a mild limitation on neck flexion. A computed tomography scan focused on the craniocervical junction revealed mottled calcification around the odontoid process. Painful neck on rotation may have diagnostic implications for crowned dens syndrome in patients with cervico-occipital pain.
