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Calcium Pyrophosphate Dihydrate Crystal Deposition(CPPD) Arthropathy of Atlantoaxial Joint 2006

General Spine

Suresh C Patel, M.D., ASSR Member
Horia Marin, M.D., Non ASSR Member

Excerpta Extraordinaire


This is a case Report of an 87-year-old female presenting with throbbing headache, radiating from the retro-orbital region to the vertex, then to her occiput on the right side, progressively getting worse over the last 3 weeks. The pain is continuous and is partially relieved by Tylenol. Neurologic examination is unremarkable. The headache has the characteristics of cervicogenic headache secondary to right occipital neuralgia. Past medical history is significant for degenerative joint disease and Calcium Pyrophosphate Dihydrate (CPPD) crystal deposition arthritis involving knee, shoulder and hand joints. There is no history of malignancy or renal disease. Laboratory values are unremarkable. There was a remote history of weakly positive rheumatoid factor (35 units (normal = 30u)). Large joint synovial fluid analysis showed presence of CPPD crystals and no evidence of inflammation to favor rheumatoid arthritis. Hand radiographs demonstrate extensive changes consistent with both ostheoarthritis and CPPD.

|MRI of the cervical spine demonstrates an enhancing soft tissue within the atlantoaxial articulation, resulting in widening of the predental space and extension into the spinal canal with mild compression of the cervicomedullary junction. CT of the cervical spine demonstrates enlargement of the predental space with anterior displacement of C1 relative to C2. There are extensive Calcium deposits both in the atlantoaxial joint and at the level of the transverse ligament. There is minimal focal bony erosion of the left side of base of dens. There is marked degenerative disc disease involving the entire cervical spine.

Given the clinical picture, history and radiologic findings, the diagnosis was cervicogenic headache secondary CPPD crystal deposition arthritis of the atlantoaxial joint.


1. Y Kakitsubata, RD Boutin, DJ Theodorou, RM Kerr, LS Steinbach, KK Chan, MN Pathria, P Haghighi, D Resnick:
2. Calcium Pyrophosphate Dihydrate Crystal Deposition in and around the Atlantoaxial Joint: Association with Type 2 Odontoid Fractures in Nine Patients. Radiology July 2000; 213-218.

Financial Disclosures: None