A 69 year old male presents with two days of atraumatic progressively worsening neck and scalp pain. He has a background of type II diabetes mellitus and chronic kidney disease.
On examination he has marked reduced range of motion of his cervical spine in all directions. He has hyperalgesia of his scalp, occiput, and posterior neck.
He has no objective neurological deficit. There is partial periodontal ligament calcification involving the superior, transverse and inferior fibres of the cruciform ligament as well as the alar ligament.
There is mild subchondral sclerosis of the anterior atlantoaxial joint. No acute cervical spine fracture.
Satisfactory bony alignment of the craniocervical junction. No gross cervical spinal malalignment.
Conclusion : Periodontal ligament calcification as described which can be seen in crowned dens syndrome in the appropriate clinical and biochemical context. Crowned dens syndrome is a rare condition caused by the deposition of calcium pyrophosphate dihydrate crystals around the odontoid process of C2.
Patients present with acute neck pain, stiffness, fevers, and elevated inflammatory markers (1).
LITFL published a clinical update in Critical Care on 22 Apr 2026.
The item focuses on CT Case 105.
Review the original article for the full source wording and details.