{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T04:25:38Z","timestamp":1768451138355,"version":"3.49.0"},"reference-count":9,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2013,3,8]],"date-time":"2013-03-08T00:00:00Z","timestamp":1362700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"},{"start":{"date-parts":[[2013,3,8]],"date-time":"2013-03-08T00:00:00Z","timestamp":1362700800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Rep Neurol"],"abstract":"<jats:p>&lt;b&gt;&lt;i&gt;Background:&lt;\/i&gt;&lt;\/b&gt; Crowned dens syndrome (CDS), related to microcrystalline deposition in the periodontoid process, is the main cause of acute or chronic cervical pain. Microcrystal-line deposition most often consists of calcium pyrophosphate dehydrate crystals and\/or hydroxyapatite crystals. &lt;b&gt;&lt;i&gt;Case Presentation:&lt;\/i&gt;&lt;\/b&gt; This report describes the case of an 89-year-old woman who presented with sudden onset, high fever, severe occipital headache, and neck stiffness. A laboratory examination revealed a markedly elevated white blood cell count (11,100\/\u00b5l) and C-reactive protein level (23.8 mg\/dl). These clinical findings suggested severe infection such as meningitis with sepsis. However, the results of blood culture, serum endotoxin, and procalcitonin were all negative, and cerebrospinal fluid studies revealed only a slight abnormality. The patient was first diagnosed with meningitis and treated with antiviral and antibiotic agents as well as non-steroidal anti-inflammatory drugs, but they only had limited effects. A cervical plain computed tomography (CT) scan and its three-dimensional (3D) reconstruction detected a remarkable crown-like calcification surrounding the odontoid process. On the basis of the CT findings, the patient was diagnosed as a severe case of CDS and was immediately treated with corticosteroids. The patient's condition drastically improved within a week after one course of corticosteroid therapy. &lt;b&gt;&lt;i&gt;Conclusion:&lt;\/i&gt;&lt;\/b&gt; Some atypical symptoms of CDS are misleading and may be misdiagnosed as meningitis, as happened in our case. A CT scan, especially a 3D-CT scan, is necessary and useful for a definitive diagnosis of CDS. CDS should be considered as a differential diagnosis of a possible etiology for fever, headache, and cervical pain of unknown origin.<\/jats:p>","DOI":"10.1159\/000348745","type":"journal-article","created":{"date-parts":[[2013,3,8]],"date-time":"2013-03-08T08:12:28Z","timestamp":1362730348000},"page":"40-46","source":"Crossref","is-referenced-by-count":20,"title":["A Rare Case of Crowned Dens Syndrome Mimicking Aseptic Meningitis"],"prefix":"10.1159","volume":"5","author":[{"given":"Teruyuki","family":"Takahashi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yugo","family":"Minakata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masato","family":"Tamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiaki","family":"Takasu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marohito","family":"Murakami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2013,3,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1093%2Frheumatology%2Fkeh370"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1002%2Fart.20915"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.2169%2Finternalmedicine.43.865"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1007%2Fs003300051052"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1002%2Fart.1780281215"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.2169%2Finternalmedicine.49.3924"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016%2FS0248-8663%2802%2900607-0"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1053%2Fsarh.2001.16650"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.3171%2Fjns.1996.85.5.0803"}],"container-title":["Case Reports in Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/348745","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/348745","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T18:58:11Z","timestamp":1745434691000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000348745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,3,8]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2013,4,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000348745","archive":["Portico"],"relation":{},"ISSN":["1662-680X"],"issn-type":[{"value":"1662-680X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,3,8]]}}}