Crowned dens syndrome combined with cervical disc herniation: A case report and literature review.

Researchers reported a rare case of an 80-year-old woman with severe neck pain caused by crowned dens syndrome (CDS), a condition involving calcium crystal deposits around a bone in the upper neck. The patient experienced intense neck pain for 10 days, difficulty rotating her head, and low-grade fever. Initially, doctors misdiagnosed her condition as a herniated disc and possible infection. Traditional treatments including pain-relief patches, acupuncture, and physiotherapy failed to provide relief, and antibiotics were ineffective when infection was suspected. The correct diagnosis came after CT scans revealed characteristic calcium deposits around the odontoid process in the upper neck, along with elevated inflammatory markers in blood tests. Once properly diagnosed, the patient responded dramatically to anti-inflammatory medications (celecoxib, colchicine, and a short course of steroids). Her fever resolved quickly, neck pain improved significantly, and inflammatory markers returned to normal within one week, with no recurrence at two-week follow-up. This case highlights an important lesson: severe neck pain in older adults may have unusual causes that require specific imaging to diagnose correctly. While acupuncture was attempted as part of initial treatment, it did not resolve symptoms in this case because the underlying cause required targeted anti-inflammatory medication. The key takeaway is that persistent, severe neck pain warrants thorough diagnostic evaluation including CT imaging to identify treatable conditions like CDS. For acupuncture treatment, always consult a licensed acupuncturist with appropriate credentials.

This case report documents an 80-year-old female with crowned dens syndrome (CDS) initially misdiagnosed as cervical disc herniation with possible intracranial infection. The patient presented with severe suboccipital neck pain, restricted cervical rotation, and low-grade fever lasting 10 days. Initial conservative treatments including pain-relief patches, acupuncture, and physiotherapy were ineffective, as was empiric antibiotic therapy. Definitive diagnosis was established via cervical CT demonstrating characteristic calcification around the odontoid process, elevated inflammatory markers (CRP and ESR), and knee radiography showing calcium deposits in cartilage and ligaments consistent with calcium pyrophosphate deposition disease. Triple therapy with celecoxib, colchicine, and short-course corticosteroids produced rapid resolution of fever, significant improvement in neck pain and mobility, and normalization of inflammatory markers within seven days. No recurrence occurred at two-week follow-up. Clinical significance: CDS should be considered in the differential diagnosis of acute severe neck pain in elderly patients. Prompt cervical CT imaging is essential to avoid misdiagnosis, unnecessary invasive procedures, and inappropriate antibiotic use.