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Crowned dens syndrome. It's never too late to diagnose
Sindrome apófisis odontoides coronada. Nunca es tarde para su diagnóstico
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Nunca es tarde para su diagnóstico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1861 "Ancho" => 1667 "Tamanyo" => 294354 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 69-year-old woman diagnosed with hemochromatosis-related arthropathy of the metacarpophalangeal, hip and knee joints, presented to the outpatient clinic with a 6-month history of severe neck pain and stiffness. She never had fever or radicular pain. On examination, there was a complete blockage of the neck rotation and a gentle limitation of flexion and extension of the neck motion, with tenderness in the cervical musculature. C-reactive protein, as a marker of acute phase response, was normal at evaluation. Medical therapy with nonsteroidal anti-inflammatory drugs and physiotherapy was unsuccessful. We suspected a crowned dens syndrome (CDS) after considering the severe pain and limitation of the neck rotation in our patient with chondrocalcinosis associated with hemochromatosis. CDS is an uncommon manifestation of calcium pyrophosphate dihydrate crystal deposition disease, involving the transverse ligament of the atlas, which is characterized by severe acute neck pain and stiffness. Computed tomography of the cervical spine showed partial “crown-like” calcification, located in the left aspect of the transverse ligament around the dens (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, arrows).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0010" class="elsevierStylePara elsevierViewall">No specific funding was received from any funding bodies in the public, commercial or not for profit sectors to carry out the work described in this article.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors have declared no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1861 "Ancho" => 1667 "Tamanyo" => 294354 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016100000001/v2_202311101438/S2387020623002589/v2_202311101438/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016100000001/v2_202311101438/S2387020623002589/v2_202311101438/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623002589?idApp=UINPBA00004N" ]
