Usefulness of cervical computed tomography and magnetic resonance imaging for rapid diagnosis of crowned dens syndrome: A case report and review of the literature

Autor: Kanehisa Kohno, Kenji Kamogawa, Haruhisa Ichikawa, Bungo Okuda, Kensho Okamoto, Shinji Iwata, Saya Ozaki, Shinya Fukumoto, Hitomi Tomita, Shiro Ohue, Satoko Ninomiya, Shinji Onoue, Akihiro Inoue
Rok vydání: 2017
Předmět:
medicine.medical_specialty
Nonsteroidal anti
Gd
gadolinium

Neurological examination
Case Report
Fluid-attenuated inversion recovery
CRP
creactive protein

03 medical and health sciences
0302 clinical medicine
medicine
CDS
crowned dens syndrome

Meningitis
ANCA
anti-neutrophil cytoplasmic antibody

Crowned dens syndrome
Neck stiffness
030203 arthritis & rheumatology
MRI findings
medicine.diagnostic_test
business.industry
3D
three-dimensional

Soft tissue
Magnetic resonance imaging
medicine.disease
NSAIDs
non-steroidal anti-inflammatory drugs

CT
computed tomography

medicine.anatomical_structure
Inflammatory drugs
Ligament
FLAIR
fluid attenuated inversion recovery

CPPD
calcium pyrophosphate dehydrate

Surgery
Radiology
business
MRI
magnetic resonance imaging

Crystalline deposition disease
030217 neurology & neurosurgery
Rare disease
Calcification
Zdroj: International Journal of Surgery Case Reports
ISSN: 2210-2612
DOI: 10.1016/j.ijscr.2016.11.045
Popis: Highlights • We report a patient with crowned dens syndrome dramatically improved following treatment with nonsteroidal anti-inflammatory medication. • This condition should be considered in the differential diagnosis of a possible etiology for fever, headache and cervical pain of unknown origin. • The rapid diagnosis of crowned dense syndrome using CT and MRI can prevent invasive, expensive and useless investigations. • It was very interesting that the soft tissue surrounding the odontoid process was hyperintense on MR T2-weighted imaging with fat suppression. • This is the first report of making reference to MRI findings of crowned dens syndrome.
Introduction Crowned dens syndrome is a rare disease entity which radiologically shows calcification of the cruciform ligament around the odontoid process. We report a patient with crowned dens syndrome who improved dramatically in 5 days following treatment with oral nonsteroidal anti-inflammatory medication. Presentation of case A 61-year-old man was admitted to our hospital with a severe occipital headache and sudden onset of neck stiffness. Neurological examination on admission revealed a high fever and cervical rigidity. Laboratory examination revealed a markedly elevated white blood cell count and C-reactive protein level, but cerebrospinal fluid studies revealed only a slight abnormality. A cervical computed tomography scan and its three-dimensional reconstruction detected a remarkable crown-like calcification surrounding the odontoid process. Cervical magnetic resonance imaging did not demonstrate strong direct compression of the cervical cord; however, the soft tissue surrounding the odontoid process was hyperintense on T2-weighted imaging with fat suppression. Based on the radiological findings, the patient was diagnosed with crowned dens syndrome and was immediately treated with non-steroidal anti-inflammatory drugs. The patient’s condition drastically improved within 5 days. Discussion It was very interesting that the soft tissue surrounding the odontoid process was hyperintense on magnetic resonance T2-weighted imaging with fat suppression, and the signal change disappeared 2 weeks after the administration of oral non-steroidal anti-inflammatory drugs. We think that magnetic resonance imaging is useful for proving inflammation in patients with crowned dens syndrome. Conclusion This is the first report making reference to the magnetic resonance imaging findings of crowned dens syndrome.
Databáze: OpenAIRE