Takahashi Teruyuki, Tamura Masato, Osabe Keiichi, Tamiya Takashi, Miki Kenji, Yamaguchi Mai, Akira Kanno, Kamei Satoshi, Takasu Toshiaki
Department of Neurology, Nagaoka-Nishi Hospital, Nagaoka, Tokyo, Japan.
Department of Neurology, Nagaoka-Nishi Hospital, Nagaoka, Tokyo, Japan ; Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Case Rep Neurol. 2014 May 9;6(2):149-55. doi: 10.1159/000362514. eCollection 2014 May.
Pain is regarded as one of the most common nonmotor symptoms in Parkinson's disease (PD). In particular, musculoskeletal pain has been reported as the most common type of PD-associated pain. Crowned dens syndrome (CDS), related to microcrystalline deposition in the periodontoid process, is the main cause of acute or chronic cervical pain.
This report describes the case of an 87-year-old woman who had severe bradykinesia, muscle rigidity, gait disturbance and neck pain. Laboratory examination revealed marked elevations of white blood cells (10,100/µl) and C-reactive protein (CRP; 8.63 mg/dl). She was primarily diagnosed with severe and untreated PD, corresponding to Hoehn and Yahr scale score IV, with musculoskeletal pain and urinary tract infection. The patient was treated with antiparkinsonism drugs, antibiotic agents and nonsteroidal anti-inflammatory drugs, but they had only limited effects. Cervical plain computed tomography (CT) scanning detected remarkable crown-like calcification surrounding the odontoid process. Based on CT findings, the patient was diagnosed as having CDS with PD, and was immediately treated with corticosteroid. The severe neck rigidity with pain and the serum CRP level (0.83 mg/dl) of the patient were drastically improved within a week by the additional corticosteroid therapy.
Severe neck rigidity and bradykinesia in this patient might have strengthened the chondrocalcinosis around the odontoid process. Cervical plain CT scan is necessary and useful for the definitive diagnosis of CDS. CDS should be considered as a differential diagnosis of a possible etiology for musculoskeletal pain related to rigidity and bradykinesia in PD.
疼痛被认为是帕金森病（PD）最常见的非运动症状之一。特别是，肌肉骨骼疼痛被报道为PD相关疼痛的最常见类型。齿突冠状征（CDS）与齿突周围微晶沉积有关，是急性或慢性颈部疼痛的主要原因。
本报告描述了一名87岁女性的病例，她患有严重的运动迟缓、肌肉僵硬、步态障碍和颈部疼痛。实验室检查显示白细胞（10,100/µl）和C反应蛋白（CRP；8.63mg/dl）显著升高。她最初被诊断为重度且未经治疗的PD，对应Hoehn和Yahr分级量表IV级，伴有肌肉骨骼疼痛和尿路感染。患者接受了抗帕金森病药物、抗生素和非甾体抗炎药治疗，但效果有限。颈部平扫计算机断层扫描（CT）检测到齿突周围有明显的冠状样钙化。根据CT结果，患者被诊断为患有CDS合并PD，并立即接受了皮质类固醇治疗。通过额外的皮质类固醇治疗，患者严重的颈部僵硬伴疼痛以及血清CRP水平（0.83mg/dl）在一周内得到了显著改善。
该患者严重的颈部僵硬和运动迟缓可能加剧了齿突周围的软骨钙质沉着症。颈部平扫CT扫描对于CDS的明确诊断是必要且有用的。CDS应被视为PD中与僵硬和运动迟缓相关的肌肉骨骼疼痛可能病因的鉴别诊断。
