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Crowned dens syndrome: a neurologist’s perspective

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Abstract

Crowned dens syndrome is an under-recognized entity that can mimic neurological disease, in particular meningitis or giant-cell arteritis. We present a 48-year-old woman presenting with an inflammatory meningitis-like syndrome with headache and neck stiffness. Lumbar puncture was normal and computed tomography (CT) of the atlantoaxial joint showed abnormal calcifications around the odontoid process, leading to a tentative diagnosis of crowned dens syndrome. In addition, signs of active inflammation in and around the dens were present on cervical MR imaging. Since CDS can mimic meningitis or giant-cell arteritis, neurologists should be aware of this entity. If CDS is suspected, the bone window on the head CT scan can lead to the diagnosis. On the other hand, asymptomatic periodontoid calcifications are common and should not preclude further investigations.

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Acknowledgements

We would like to thank radiologists Philip Van Hover M.D. and Ignace Boelaert M.D. for providing (their advice on) the radiological images.

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Authors and Affiliations

  1. Department of Neurosciences, Experimental Neurology, University of Leuven, Leuven, Belgium

    Lauranne Scheldeman

  2. Laboratory of Neurobiology, Center for Brain and Disease Research, VIB, Leuven, Belgium

    Lauranne Scheldeman

  3. Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Lauranne Scheldeman

  4. Department of Rheumatology, OLV Aalst, Aalst, Belgium

    Marijke Van Hoydonck

  5. Department of Radiology, OLV Aalst, Aalst, Belgium

    Ruben Vanheste

  6. Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium

    Tom Theys

  7. Department of Neurology, OLV Aalst, Aalst, Belgium

    Gert Cypers

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  1. Lauranne Scheldeman
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  2. Marijke Van Hoydonck
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  3. Ruben Vanheste
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  4. Tom Theys
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Correspondence to Lauranne Scheldeman.

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Scheldeman, L., Van Hoydonck, M., Vanheste, R. et al. Crowned dens syndrome: a neurologist’s perspective. Acta Neurol Belg 119, 561–565 (2019). https://doi.org/10.1007/s13760-019-01153-z

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  • DOI: https://doi.org/10.1007/s13760-019-01153-z

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