Síndrome de la apófisis odontoides coronada, una manifestación inusual de dolor cervical. Presentación de un caso / Crowned Dens Syndrome, an Unusual Manifestation of Cervical Pain. A Case Report

Resumen Las enfermedades por depósito de cristales de pirofostato dehidratado de calcio o hidroxiapatita se pueden manifestar en cualquier articulación, y cuando se acumulan en la columna cervical pueden ser causa de dolor. El síndrome de la apófisis odontoides coronada es una rara condición clínica que se presenta por calcificación, en forma de corona, de los ligamentos que rodean a la apófisis odontoides. Se presenta el caso de un hombre de 70 años, con una semana de cervicalgia, cefalea y fiebre, que ingresó por sospecha de patología neurológica. Se realizó tomografía computarizada (TC) de cráneo que documentó calificaciones lentiformes del ligamento transverso del atlas. Se instauró manejo con corticoides y antiinflamatorios no esteroideos con mejoría. Una adecuada anamnesis junto con estudio por imagen evita procedimientos innecesarios y permite incluir esta entidad en el diagnóstico diferencial del dolor cervical agudo.

Abstract The calcium pyrophosphate dehydrate (CPPD) or hydroxyapatite (HA) crystal deposition disease can appear in any joint and the accumulation fo crystals in the cervical spine may be painful. Crowned dens syndrome is a rare clinical condition that involves crown-like calcification of the ligaments around the odontoid process. A 70-year-old man presented cervical pain, fever and a headache for over a week, therefore, a neurological condition was suspected. A CT scan revealed lentiform calcifications of the transverse ligament of the atlas. Steroid treatment and a non-steroidal anti-inflammatory diminished the symptoms. A proper clinical history and imaging studies avoid unnecessary procedures and makes it possible to include this entity as a differential diagnosis in acute cervical pain.

A Case of CPPD Crystal Deposition Disease in a Patient with Rheumatoid Arthritis and Systemic Sclerosis / 대한류마티스학회지

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structures. CPPD crystal deposition disease has various clinical manifestation patterns ranging from an absence of symptoms to a severely destructive arthropathy. CPPD crystal deposition disease very rare with rheumatoid arthritis or systemic sclerosis. We report a case of CPPD crystal deposition disease combined in a patient with rheumatoid arthritis and systemic sclerosis.

Idiopathic Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease in a Young Female Patient : A Case Report

PURPOSE: Calcium pyrophosphate dihydrate crystal deposition disease(CPPD) is a disease of the elderly and extremely rare in young individuals. If young people develop CPPD crystal deposition disease, it may be associated with metabolic diseases, such as hemochromatosis, hyperparathyroidism, hypophosphatasia, hypomagnesemia, Wilson's disease, hypothyroidism, and gout. MATERIALS AND METHODS: Therefore, in young-onset CPPD crystal deposition disease, an investigation of any predisposing metabolic conditions is warranted. CONCLUSION: We report a case of a young female patient who presented with idiopathic CPPD crystal deposition disease at 25 years of age.

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease in the Cervical Ligamentum Flavum: A Case Report / 대한척추외과학회지

Calcium pyrophosphate dihydrate deposition disease (CPPD) is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structures. The cervical ligamentum flavum is a rare location of CPPD deposition. A 65-year-old woman was admitted with complaints of neck pain and a tingling sensation and numbness below the xiphoid process for 2 months. Magnetic resonance (MR) imaging and computed tomography (CT) revealed compression of the spinal cord due to a nodular calcified mass in or attached to the ligamentum flavum at the C4-5, C5-6, or C6-7 level. The patient underwent a laminectomy at C4-5, C5-6, and C6-7, and resectioning of calcified extradural nodules that impinged on the cervical cord. The operation resulted in a resolution of neck pain and hypoesthesia, except in the feet. Histopathological examination of the excised specimen revealed rectangular CPPD crystals. Here, we report a case of compressive cervical spine due to CPPD deposition disease of the cervical spine and describe the literature relevant to CPPD deposition disease of the cervical spine.

Extra-articular arthroscopic treatment of rotator cuff calcifying tendonitis / 中国矫形外科杂志

[Objective]To evaluate the surgical technique and effectiveness of extra-articular arthroscopic debridement in patients with rotator cuff calcifying tendinitis unresponsive to conservative treatment.[Methods]Arthroscopic debridement was performed in 18 patients(5 males,13 females;mean age 56.4,range 34 to 78) in whom pain and functional disability persisted for more than 3 months despite conservative therapy for rotator cuff calcifying tendinitis.Arthroscopy was inserted into subacromial interspace and bursectomy was done.Calcified plaques in supraspinatus tendon were explored and eliminated outside shoulder joint under arthroscopy.VAS pain score,Constant-Murley score and plain radiograph was adopted for evaluation before and after surgery.[Results]The mean follow-up period was 9 months(6 to 15 months)[KG-58x].Pain and functional disturbance of the shoulder disappeared or obviously improved.The average VAS pain score was(7.8?0.6) preoperatively and(1.7?0.4) postoperatively.The average Constant-Murley score was(61?7)preoperatively and(91?4)at the last follow-up.Radiograph showed little residual deposits in 2 cases but without preoperative symptoms.No case need rotator cuff repair.[Conclusion]Extra-articular arthroscopic removal of calcium deposits together with bursectomy is effective and reliable in patients with chronic calcifying tendinitis unresponsive to conservative treatment.

Idiopathic Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease in a Young Male Patient: A Case Report

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is a disease of the elderly and extremely rare in young individuals. If young people develop CPPD crystal deposition disease, it may be associated with metabolic diseases such as hemochromatosis, hyperparathyroidism, hypophosphatasia, hypomagnesemia, Wilson's disease, hypothyroidism, gout, acromegaly, and X-linked hypophosphatemic rickets. Therefore, in young-onset polyarticular CPPD crystal deposition disease, investigation for predisposing metabolic conditions is warranted. We report a case of a young male patient with idiopathic CPPD crystal deposition disease, who did not have any evidences of metabolic diseases after thorough evaluations. As far as we know, this is the first report of a young male patient presented with idiopathic CPPD crystal deposition disease.

A Case of Calcium Pyrophosphate Dihydrate Crystal Deposition Disease Associated with Gout / 대한류마티스학회지

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease has various patterns of clinical manifestation ranging from an absence of symptoms to a severely destructive arthropathy. A number of metabolic diseases and physiologic stresses, such as aging and trauma, have been associated with CPPD crystal deposition. The coexistence of CPPD crystal deposition disease and gout varies from 2 to 8%. The mechanism of this association has been postulated to be a predisposition to the local deposition of pyrophosphate due to the presence of urate crystal, perhaps acting as a nucleating agent or factor which predispose to the deposition of both kinds of crystals. In Korea, although it is considered that CPPD crystal deposition occasionally coincides monosodium urate crystal, it has not been reported so far. We report a case with CPPD crystal deposition disease combined with gout in a patient who has suffered from osteoarthritis, which is diagnosed by polarized microscopic examination of synovial fluid.

Calcium Pyrophosphate Dihydrate (CPPD)Crystal Deposition Disease Mimicking Meningitis:A case Report and Review of the Literature / 대한류마티스학회지

Calcium pyrophosphate dihydrate (CPPD)crystal deposition disease is one of the most common causes of arthralgia in elderly.The acute form (pseudogout) may present as acute monoarticular or polyarticular arthritis.It is often accompanied by high fever and sometimes simulates acute infectious condition.The knee is the joint most frequently affected by pseudogout but other sites such as wrist,shoulder,ankle,elbow and hands may be affected.A few cases involving cervical and lumbar spine mistaken for CNS infection have also been described in foreign countries.We report here a case of CPPD crystal deposition disease mimicking meningitis.