Painful neck on rotation: diagnostic significance for crowned dens syndrome.

The crowned dens syndrome (CDS) is a clinicoradiological entity defined as acute neck pain due to deposition of crystals surrounding the odontoid process. Crystal deposition may occur without symptoms or exhibit myelopathy by compressing the spinal cord. Neck pain on lateral rotation has been described in the previous papers for CDS. We tested the validity of "painful neck on rotation" as a potential diagnostic tool to differentiate CDS from meningeal irritation. Patients 1 and 2 were relatively young females and showed acute cervico-occipital pain, with marked limitation on neck rotation. Patient 2 was suspected to have neck strain, since there was no fever and no elevated CRP. In contrast, patient 3 was an older female and showed headache and limitation of neck rotation. Cerebrospinal fluid was normal in spite of inflammatory reaction on laboratory markers. All three patients showed absence of or only a mild limitation on neck flexion. A computed tomography scan focused on the craniocervical junction revealed mottled calcification around the odontoid process. Painful neck on rotation may have diagnostic implications for CDS in patients with cervico-occipital pain.

Oxytocin content of the cerebrospinal fluid of dogs and its relationship to pain induced by spinal cord compression.

OBJECTIVES: To determine whether oxytocin exists in the cerebrospinal fluid (CSF) of dogs and whether the amount of oxytocin in the CSF of dogs with neck or back pain caused by spinal cord compression is significantly different than that in the CSF of clinically normal dogs. STUDY DESIGN: Prospective controlled study. ANIMAL POPULATION: A total of 15 purpose-bred beagles and 17 client-owned dogs. METHODS: CSF was collected by needle puncture of the cerebellar medullary cistern after induction of general anesthesia. Oxytocin levels within the samples were determined through radioimmunoassay. RESULTS: Dogs with spinal cord compression had significantly more oxytocin in their CSF than the clinically normal dogs (13.76 +/- 2.0 pg/mL and 3.61 +/- 0.63 pg/mL, respectively; P < .0001). Dogs with chronic signs (>7 days) had significantly more oxytocin in their CSF than dogs with acute signs (<7 days) (21.60 +/- 0.86 pg/mL and 6.80 +/- 0.81 pg/mL, respectively; P < .0001). Both acutely and chronically affected dogs had significantly more oxytocin in their CSF than the controls (P < .005 and P < .0001 respectively). CONCLUSIONS: Dogs with neck and back pain caused by spinal cord compression have significantly more oxytocin in their CSF than clinically normal dogs. Dogs with chronic clinical signs have significantly more oxytocin in their CSF than dogs with acute clinical signs. CLINICAL RELEVANCE: In humans, intrathecal injection of oxytocin is effective in treating low back pain for up to 5 hours. Intrathecal oxytocin may be a logical choice for perioperative analgesia in dogs undergoing myelography because the intrathecal space is accessed for injection of contrast agent.