BACKGROUND AND PURPOSE: Crowned dens syndrome is an ill-known etiology of acute 
neck pain.
METHODS: We carried out a retrospective study of 18 cases of patients with 
crowned dens syndrome, assessing clinical and radiological features.
RESULTS: The results of our study are comparable to data from the literature. 
The clinical presentation of acute febrile neck pain, occipital headache and 
multidirectional stiff neck especially affects women aged over 60. No 
predisposing factor was recognized. However, a history of peripheral joint 
chondrocalcinosis may reinforce the diagnosis. In more than 50% of cases, 
laboratory tests showed a marked inflammatory syndrome. The diagnosis was 
obtained with cervical CT-scan focusing on the C1/C2 joint. This gold standard 
test was able to show a calcification of the cruciform ligament in connection 
with deposits of calcium pyrophosphate crystals in almost 80% of cases. Other 
imaging tests provided little information, including standard radiographs of the 
cervical spine. MRI can eliminate some differential diagnoses such as infections 
or neurological emergencies. Complications are infrequent. The standard 
treatment is based on anti-inflammatory drugs (NSAID, colchicine) or 
corticosteroids. These treatments are highly effective: a drammatic full 
recovery of cervical mobility may be observed within 48 hours. In over half of 
cases, a different diagnosis was initially made, responsible of unnecessary 
additional tests and treatment.
CONCLUSION: A comprehensive consultation, a complete clinical examination and a 
precise analysis of the imaging will avoid certain investigations and rule out 
differential diagnoses.