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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., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Articular chondrocalcinosis (ACC), which is due to the precipitation of calcium pyrophosphate microcrystals, is known to produce symptom of acute arthritis or chronic degenerative polyarticular lesions. It is more rarely responsible for rapidly destructive lesions of the joints suggesting a metabolic or neurological process. The case reported here of a 66 year old woman with major lesions of the L1-L2 intervertebral space, together with other cases already published, shows that the destructive spinal forms of ACC may also present as subacute spondylodiscitis. The latter, however, merely represents 4.9% of all destructive articular lesions of ACC and 5.2% of the vertebral localizations of all forms of the disease.

Three cases of X-linked vitamin-resistant rachitism and discovered in adult life are reported. In all 3 cases there were morphological anomalies affecting mainly the limbs which were incurved and reduced stature. In two of the patients the disorder was progressive and presented as pain, walking difficulties, and Looser-Milkman striae. In the third case the hypophosphatemia was asympomatic, but it enabled the early diagnosis of a progressive rachitic disorder in the patient's child; treatment with 1-25 dihydroxycholecalciferol alone caused renewed growth, disappearance of radiological anomalies, and regression of biological disorders. Articular chondrocalcinosis was also present in one of the patients. This could be a coincidence and systematic search for this condition in cases of vitamin-resistant rachitism will be necessary to establish a possible relationship between the two affections.

Two adults patients presenting Bartter's syndrome have been studied for 9 years in one case, 7 years in the other. Both were affected with chondrocalcinosis. This association does not seem to be coincididental but suggests a pathogenic link between Bartter's syndrome and chondrocalcinosis; the two patients presented hypomagnesemia which, inhibiting intrasynovial pyrophosphatase, induces calcium pyrophosphate crystals deposits on fibrocartilages. Otherwise, excessive daily urinary excretion of PG E2 and PG F2 alpha was found in both patients. Indomethacin (150 mg daily) decreased urinary excretion of PG to normal values in the two cases, Kalaemia was completely normalized in one case, partially in the other.