Crowned dens syndrome: a rare differential diagnosis of meningitis

We report the case of an 84-year-old female who presented herself to the emergency department with general weakness, chills, cephalgia and neck pain. Initial vital signs were remarkable for an elevated heart (102/min) and respiratory rate (20/min) and fever (38.1 °C). The onset of symptoms was 1 day prior to admission. The physical examination revealed a marked neck stiffness with an inability to rotate the head or bend it forward. Blood tests were remarkable for elevated levels of C-reactive protein (156.6 mg/l, reference range < 5 mg/l), lactate (37 mg/dl, reference range 5–20 mg/dl) and leukocytes (20.68/nl, reference range 3.9–10.5/nl). A lumbar puncture yielded values within the normal range for cell count, lactate and glucose in the cerebrospinal fluid. A computed tomography of the cervical spine was performed and showed signs typical of crowned dens syndrome