J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website http://www.jofem.org

Original Article

Volume 6, Number 5, October 2016, pages 143-148

Incidence, Age and Gender of Subjects With the Calcium Pyrophosphate Deposition Around the Dens, and Clinical Characteristics of Patients With Crowned Dens Syndrome

Figure 1. The calcifications around the dens by computed tomography in three patients diagnosed as having crowned dens syndrome. The axial cervical CT shows semicircular calcification (arrow-heads) at the posterolateral side of the dens. (a), (b) and (c) are CT of cases 2, 3 and 4 in Table 2.

Figure 3. Age distribution and mean age in subjects with and without the calcification around the dens in all subjects (a) and subjects who were over 65 years old (b). Values on the side of horizontal bars indicate mean age.

Figure 4. The axial cervical computed tomography (CT) image (a) and the sagittal CT image (b) of case 10 in Table 2. CT showed the calcification (arrow-heads) at the posterolateral side of the dens.

Figure 5. Magnetic resonance imaging of case 10 in Table 2. (a) and (b) are T2-weighted image and diffusion-weighted image, respectively. High-intensity area (area inside the circle) was observed in both T2-weighted image and diffusion-weighted image, suggesting the existence of pyogenic spondylodiscitis in C5 and C6 vertebrae and the C5-C6 disc.

**Table 1.** Age, Gender and Frequency of Calcifications Around the Dens in All Eligible Subjects, and Frequency of Calcifications Around the Dens in Subjects Who Were Over 65 Years Old, and Gender in Subjects With Calcifications Around the Dens
All eligible subjects (n = 365)
Range of age (years)	6 - 99
Male/female (n)	169/196
Calcification around the dens
Absence, n (%)	343 (94.2%)
Presence, n (%)	21 (5.8%)
Subjects who were over 65 years old (n = 208)
Calcification around the dens
Absence, n (%)	188 (90.4%)
Presence, n (%)	20 (9.6%)
Subjects with calcification around the dense (n = 21)
Male/female (n)	6/15

Table 1. Age, Gender and Frequency of Calcifications Around the Dens in All Eligible Subjects, and Frequency of Calcifications Around the Dens in Subjects Who Were Over 65 Years Old, and Gender in Subjects With Calcifications Around the Dens

All eligible subjects (n = 365)

Range of age (years)

6 - 99

Male/female (n)

169/196

Calcification around the dens

Absence, n (%)

343 (94.2%)

Presence, n (%)

21 (5.8%)

Subjects who were over 65 years old (n = 208)

Calcification around the dens

Absence, n (%)

188 (90.4%)

Presence, n (%)

20 (9.6%)

Subjects with calcification around the dense (n = 21)

Male/female (n)

6/15

**Table 2.** Age, Sex, Symptoms, Body Temperature, Changes in CRP Levels, Treatment and Clinical Course in Patients Diagnosed as Having Crowned Dens Syndrome
Cases	Age/sex	Symptoms	BT (°C)	Changes in CRP levels (mg/dL)	Treatment	Clinical course
BT: body temperature; CRP: C-reactive protein; F: female; M: male; PSL: prednisolone.
1	85/F	Neck pain, restricted neck rotation	37.9	0.57 → 1.57 (day 3) → 0.22 (day 7)	Celecoxib 400 mg/day	Symptoms and fever were promptly ameliorated on day 2
2	79/F	Neck pain, restricted neck rotation, polyarthralgia	38.0	23.91→ 10.01 (day 2) → 1.25 (day 7)	Celecoxib 400 mg/day, PSL 10 mg/day	Symptoms were ameliorated on day 2, and fever was gone on day 5
3	69/M	Neck pain, restricted neck rotation	37.6	4.63 → 0.91 (day 4) → 0.35 (day 6)	PSL 15 mg/day	Symptoms and fever were promptly ameliorated on day 2
4	92/F	Neck pain, restricted neck rotation	37.5	9.72 → 3.85 (day 2) → 0.36 (day 6)	Celecoxib 400 mg/day	Symptoms were gradually ameliorated, and fever was gone on day 3
5	85/F	Neck pain, restricted neck rotation	38.4	14.33 → 5.88 (day 5) → 4.21 (day 7)	No medication	Symptoms were promptly ameliorated on day 1, and fever was gone on day 2
6	87/F	Neck pain, restricted neck rotation	38.1	5.99 → 1.38 (day 4) → 0.37 (day 7)	Celecoxib 400 mg/day	Symptoms were promptly ameliorated on day 1, and fever was gone on day 2
7	85/M	Neck pain, restricted neck rotation	37.5	11.14 → 6.45 (day 4) → 6.05 (day 9)	Sulindac 200 mg/day → loxoprofen180 mg/day (from day 4)	Symptoms were promptly ameliorated on day 2, and fever was gone on day 3
8	84/M	Neck pain, restricted neck rotation	37.4	14.06 → 8.36 (day 2) → 1.10 (day 7)	Celecoxib 400 mg/day	Symptoms were promptly ameliorated on day 1, and fever was gone on day 2
9	82/M	Neck pain, restricted neck rotation, polyarthralgia	39.2	12.45 → 7.42 (day 2) → 0.52 (day 4)	PSL 30 mg	Symptoms were promptly ameliorated on day 1, and fever was gone on day 2
10	79/F	Neck pain, restricted neck rotation	38.3	14.30 → 16.41 (day 1)	Celecoxib 400 mg/day	Any amelioration in symptoms and fever were not observed on day 2

Table 2. Age, Sex, Symptoms, Body Temperature, Changes in CRP Levels, Treatment and Clinical Course in Patients Diagnosed as Having Crowned Dens Syndrome

Cases

Age/sex

Symptoms

BT (°C)

Changes in CRP levels (mg/dL)

Treatment

Clinical course

BT: body temperature; CRP: C-reactive protein; F: female; M: male; PSL: prednisolone.

85/F

Neck pain, restricted neck rotation

37.9

0.57 → 1.57 (day 3) → 0.22 (day 7)

Celecoxib 400 mg/day

Symptoms and fever were promptly ameliorated on day 2

79/F

Neck pain, restricted neck rotation, polyarthralgia

38.0

23.91→ 10.01 (day 2) → 1.25 (day 7)

Celecoxib 400 mg/day, PSL 10 mg/day

Symptoms were ameliorated on day 2, and fever was gone on day 5

69/M

Neck pain, restricted neck rotation

37.6

4.63 → 0.91 (day 4) → 0.35 (day 6)

PSL 15 mg/day

Symptoms and fever were promptly ameliorated on day 2

92/F

Neck pain, restricted neck rotation

37.5

9.72 → 3.85 (day 2) → 0.36 (day 6)

Celecoxib 400 mg/day

Symptoms were gradually ameliorated, and fever was gone on day 3

85/F

Neck pain, restricted neck rotation

38.4

14.33 → 5.88 (day 5) → 4.21 (day 7)

No medication

Symptoms were promptly ameliorated on day 1, and fever was gone on day 2

87/F

Neck pain, restricted neck rotation

38.1

5.99 → 1.38 (day 4) → 0.37 (day 7)

Celecoxib 400 mg/day

Symptoms were promptly ameliorated on day 1, and fever was gone on day 2

85/M

Neck pain, restricted neck rotation

37.5

11.14 → 6.45 (day 4) → 6.05 (day 9)

Sulindac 200 mg/day → loxoprofen180 mg/day (from day 4)

Symptoms were promptly ameliorated on day 2, and fever was gone on day 3

84/M

Neck pain, restricted neck rotation

37.4

14.06 → 8.36 (day 2) → 1.10 (day 7)

Celecoxib 400 mg/day

Symptoms were promptly ameliorated on day 1, and fever was gone on day 2

82/M

Neck pain, restricted neck rotation, polyarthralgia

39.2

12.45 → 7.42 (day 2) → 0.52 (day 4)

PSL 30 mg

Symptoms were promptly ameliorated on day 1, and fever was gone on day 2

79/F

Neck pain, restricted neck rotation

38.3

14.30 → 16.41 (day 1)

Celecoxib 400 mg/day

Any amelioration in symptoms and fever were not observed on day 2

**Table 3.** Clinical, Biochemical and Radiological Characteristics for Crowned Dens Syndrome
CRP: C-reactive protein; CT: computed tomography; NSAIDs: non-steroidal anti-inflammatory drugs.
1	Elderly people
2	Neck pain, restricted neck rotation and fever
3	Elevated serum CRP levels
4	The calcification around the dens detected by CT
5	The prompt response to steroid and/or NSAIDs

Table 3. Clinical, Biochemical and Radiological Characteristics for Crowned Dens Syndrome

CRP: C-reactive protein; CT: computed tomography; NSAIDs: non-steroidal anti-inflammatory drugs.

Elderly people

Neck pain, restricted neck rotation and fever

Elevated serum CRP levels

The calcification around the dens detected by CT

The prompt response to steroid and/or NSAIDs