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Background
Crowned dens syndrome (CDS) is acute neck pain caused by pseudogout of the atlantoaxial junction in cervical spines and requires only conservative a short-term management with non-steroidal anti-inflammatory drugs or steroids. 1 However, because its symptoms mimic those of several diseases, including meningitis, 2-4 CDS patients often receive unnecessary tests, including invasive diagnostic procedures.
We report a case of CDS who had been brought through ambulances four times between several hospitals and received extensive tests, including lumbar puncture, until the correct diagnosis was made. Here, we propose a novel physical finding for making the correct diagnosis in patients with CDS.
Case presentation
A woman aged 88 years with hypertension presented with a 4-day history of severe neck pain to the first hospital by ambulance. In the first hospital, she underwent extensive tests. There was no evidence of acute coronary syndrome and cerebrovascular disorder, and thus, she was brought through first emergency transport to another community hospital.
In this second hospital, meningitis was suspected because jolt accentuation was positive on physical examination. Thereafter, she was brought through third transport to another general hospital for further evaluation of possible meningitis. However, cerebrospinal fluid test was performed, showing normal results. Since the cause for the neck pain was unclear, she was brought through fourth transport to our hospital.
On examination, she appeared ill...