Overview
Dens evaginatus, also known as crowned dens syndrome (CDS), is a form of acute calcium pyrophosphate dihydrate (CPPD) crystal deposition disease characterized by inflammation around the dens (odontoid process) of the axis vertebra, leading to neck pain and mimicking conditions like meningitis 12.Diagnosis
Clinical Presentation: Neck pain exacerbated by axial neck rotation, often mistaken for meningitis symptoms like headache 1.
Physical Examination: Jolt accentuation of neck pain rather than headache is a distinguishing feature 1.
Imaging: Radiographic imaging may show characteristic changes around the dens, though not always definitive 2.
Laboratory Tests: Elevated inflammatory markers (e.g., ESR, CRP) are common 2.
Crystal Identification: Synovial fluid analysis demonstrating CPPD crystals can confirm diagnosis 2.Management
First-Line Treatment: Non-steroidal anti-inflammatory drugs (NSAIDs) are highly effective for symptom relief 2.
Adjunctive Measures: Corticosteroids may be considered in cases refractory to NSAIDs 2.
Supportive Care: Pain management and monitoring for complications such as atlantoaxial subluxation 2.Special Populations
Post-ERCP Patients: CDS should be considered in differential diagnosis for patients presenting with fever and neck pain following endoscopic retrograde cholangiopancreatography 2.Key Recommendations
Consider dens evaginatus (CDS) in patients with neck pain exacerbated by neck rotation, especially post-ERCP procedures, and differentiate from meningitis using specific physical exam findings 12 (Evidence: Moderate).
Initiate treatment with NSAIDs for symptom relief in confirmed cases of CDS 2 (Evidence: Moderate).
Monitor inflammatory markers and consider corticosteroids if NSAIDs fail to control symptoms 2 (Evidence: Moderate).References
1 Kurihara M, Tokuda Y. Jolt accentuation of neck pain: a novel physical finding for crowned dens syndrome. BMJ case reports 2016. link
2 Nakano H, Nakahara K, Michikawa Y, Suetani K, Morita R, Matsumoto N et al.. Crowned dens syndrome developed after an endoscopic retrograde cholangiopancreatography procedure. World journal of gastroenterology 2016. link