Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine
Acute pain in the neck (neck pain) can be indicative of a rare disease such as crown tooth syndrome (in English Crowned Dens Syndrome). This syndrome was first described by Dirheimer et Wackenheim in 1974. It is a disease generally found in women over the age of 60. This syndrome presents clinical manifestations commonly of the type of febrile neck pain which can be confused with other pathologies such as meningitis or spondylodiscitis.
This article will provide readers with a clearer definition of crown tooth syndrome, to know its symptoms as well as the means of diagnosis, then finally to know how to treat it.
Le crown tooth syndrome is defined by the existence of deposits of calcium crystals (calcium pyrophosphate or apatite), in the articular structures of theodontoid. The odontoid process is a peg-shaped bone that points upward from the second vertebrate cervical (C2). It is connected to the first cervical vertebra (C1) and allows the rotation of the head.
Crowned tooth syndrome occurs when too many calcium deposits form on the teeth. intervertebral discs of the first two vertebrae cervical. Indeed, these calcium crystals can be found in the synovial membrane, the articular capsule as well as the ligaments which surround the bone, which can resemble a "crown" and cause excruciating pain in the neck.
The main causes of this syndrome are articular chondrocalcinosis and hydroxyapatite rheumatism. Articular chondrocalcinosis is a microcrystalline arthropathy (pathology of the joints) characterized by precipitation of crystals of calcium pyrophosphate in the cartilages and fibrocartilages, in particular the knees, the pubic symphysis, the wrist as well as the intervertebral discs and the transverse ligament of the atlas (C1).
Symptoms of the disease
Symptoms of crown tooth syndrome may include one or more of the following clinical manifestations:
- neck pain high, at the base of the skull. This symptom is the most common and is likely to be felt as intensely acute, especially with movement.
- Neck stiffness. This is difficulty moving the neck due to pain and inflammation.
- Fever. The patient may have a high temperature and other signs of inflammation.
- Neurological problems. If the spinal cord is compressed by the crystalline formations towards the top of the cervical spine, the myelopathy can develop. The patient will then present the signs related to his myelopathy namely pain, tingling and/or numbness in all parts of the body below the upper neck. There will also be reduced arm and/or leg strength and coordination, and/or reduced bowel and bladder control.
CT scan (scanner) of the cervical spine is the paraclinical examination of choice that will confirm crowned tooth syndrome. Axial and coronal views centered on C1-C2 are the most recommended. They will highlight a calcification of the transverse ligament of the atlas in half crown, dense, surrounding the posterior part of the odontoid.
On the biological level, we can have an elevation of markers of inflammation such as CRP (C-reactive Protein) and SV (sedimentation rate).
The differential diagnosis will be made, in a subject over 60 years old, with infectious meningitis, the spondylodiscitis cervical, the rheumatoid arthritis, the cervical tumor.
Treatment for crown tooth syndrome is usually nonsurgical with medications such as:
- nonsteroidal anti-inflammatory drugs (NSAIDs),
- and corticosteroids like prednisolone.
Most cases of symptomatic crown tooth syndrome resolve within weeks or months, following likely resorption of calcium deposits. In cases where symptoms persist for longer, surgery may be considered, especially if signs of a spinal compression appear.
Le crown tooth syndrome is a diagnosis to consider in elderly patients with fever, neck pain and inflammatory markers high.
Le CT scan of the cervical spine is the radiological examination of choice to confirm the diagnosis.
Early diagnosis therefore avoids unnecessary invasive tests and the wrongful administration of antibiotics in this vulnerable population. Simple anti-inflammatories are sufficient and the evolution is rather good under treatment.
However, the physician should watch for signs of spinal compression which is the complication to be feared.
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