急性頚部痛で発症した環椎石灰沈着症の1症例

Acute Neck Pain Caused by Calcium Pyrophosphate Dehydrate Deposition in the Transverse Ligament of the Atlas: A Case Report

Ⅰ．はじめに

　急性頚部痛を生じる疾患として，頚椎症などの変性疾患，硬膜外血腫，椎骨動脈解離性動脈瘤などの血管性病変，脊椎腫瘍などさまざまな病態が考えられるが，その1つに椎体周囲への石灰沈着によるものが挙げられる．多くは偽痛風の部分兆候で，軸椎歯突起周囲にcalcium pyrophosphate dehydrateが沈着し，頚部痛や発熱を生じる疾患である．今回われわれは，急性の頚部痛を来した環椎石灰沈着症（crowned dens syndrome）の1例を経験した．このような症例は日常診療で見逃されている可能性も示唆される．過去の文献例を含め報告する．

　We report a case of pseudogout manifested by severe posterior neck pain. Pseudogout of the neck,also known as the crowned dens syndrome,causes acute neck pain characterized by calcium pyrophosphate dehydrate deposition around the odontoid process. Crowned dens syndrome is typified clinically by severe cervical pain and stiffness,often in conjunction with raised inflammatory markers. A 71-year-old man presented with severe neck pain. On admission,elevation of serum CRP level was confirmed. Magnetic resonance images showed no responsible abnormalities except for degenerating change of the spine. The patient was diagnosed as having pseudogout caused by calcium pyrophosphate dehydrate deposition based on cervical computed tomographic imaging,which showed linear calcification in the transverse ligament of the axis. After administration of non-steroidal anti-inflammatory drugs,the fever and neck pain disappeared and the CRP level returned to within the normal range. Pseudogout of the cervical spine should be considered as a differential diagnosis when we examine patients with acute neck pain. Cervical spinal computed tomographic scan is a more sensitive and useful examination method to diagnose this disease rather than magnetic resonance images.