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Final Program


Final Congress Guide

Clinical Sciences/Health Conditions

200 Section - A Diagnostic Challenge: Crowned Dens Syndrome Presenting as Acute Cervical Pain

Wednesday, May 20, 2026
6:00 PM - 7:30 PM PT
Case Diagnosis: Crowned Dens Syndrome

Case Description: A 63-year-old man with fibromyalgia and chronic pain syndrome presented with progressively worsening diffuse myalgia and severe neck pain over several days. Two weeks prior, he experienced a fibromyalgia flare, right ankle swelling, and sharp cervical pain radiating to the occipital region. Despite adherence to his usual pain regimen, symptoms persisted. The neck pain was pulsatile, continuous, and rated 8/10 on the Visual Analogue Scale, worsened by neck movement and improved by remaining still. Examination showed limited cervical range of motion and marked bilateral cervical paraspinal tenderness. Inflammatory markers (ESR and CRP) were elevated. Radiographs of the knees, wrists, and shoulder revealed significant chondrocalcinosis. Cervical CT demonstrated multilevel facet arthropathy and crescent-shaped calcifications around the odontoid process, consistent with a “crowned dens” appearance. Low-dose corticosteroids were initiated, resulting in prompt symptomatic improvement.

Discussions: Crowned dens syndrome (CDS) results from acute inflammation of the upper cervical spine due to calcium crystal deposition around the odontoid process, causing neck pain and restricted motion. Although uncommon, CDS is likely underdiagnosed and may account for ~2% of acute neck pain cases. The patient’s underlying fibromyalgia and chronic widespread pain may have obscured the acute inflammatory nature of the presentation, delaying recognition. This case emphasizes the importance of maintaining suspicion for CDS in older adults with acute, severe neck pain, even when chronic pain disorders are present.

Conclusions: CDS is an underrecognized but treatable cause of acute neck pain in older adults. It should be considered in elderly patients presenting with acute neck pain and stiffness, particularly those with systemic chondrocalcinosis. CT imaging of the craniovertebral junction is essential for diagnosis and distinguishing it from infectious or other rheumatologic conditions. Early recognition and anti-inflammatory therapy, such as corticosteroids, typically lead to rapid symptom resolution. Accurate diagnosis is essential for guiding appropriate management.