Thread by @guerreroespejo

An 85-YO👨‍🦳, chronic kidney disease, gouty arthritis: fever, neck pain & stiffness.

WBC & CRP:⬆️
MRI suggested cervical meningitis (A): enhancement along the epidural space (arrows), & thin enhancement in a portion of the meninges (arrowheads).

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#neurology #radiology

CSF: not meningitis, & CSF🧫& molecular tests ➖ for bacteria & mycobacteria

CT: calcifications of the transverse ligament of the atlas (B).

Diagnosed with crowned dens syndrome: 20 mg prednisolone, & his symptoms dramatically improved.
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#rheumatology #radres #emergency

However, CSF examination under polarising microscopy revealed monosodium urate crystals (C).
Dual-energy CT confirmed the calcifications to be monosodium urate crystals (D).
Uric acid:⬆️
MONOSODIUM URATE CRYSTALS IN CSF THAT CAUSED MENINGITIS-LIKE SYMPTOMS
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#neurology #MedEd

Crowned dens síndrome is:
📌a rare finding in calcium pyrophosphate deposition disease
📌typically encountered in elderly patients and
📌could be clinically similar to meningitis
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DOI:doi.org/10.1016/S2665-…
#IDtwitter #MedTwitter #radres

The patient:
📌history of gout, &
📌monosodium urate crystals by CSF analysis & dual-energy CT,
suggesting GOUT FLARE IN THE CERVICAL SPINE

Intrathecal monosodium urate crystal formation can cause meningitis-like symptoms in patients with gout history.
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#resident #medicine