Jolt accentuation of neck pain: a novel physical finding for crowned dens syndrome.

Crowned dens syndrome (CDS), a pseudogout attack involved with atlantoaxial joint, mimics meningitis, because jolt accentuation of headache, a physical sign for meningitis, is frequently considered mistakenly as 'positive' in CDS patients. Our patient with CDS experienced multiple ambulance transports and underwent lumbar puncture for suspected meningitis because of positive result of jolt accentuation of headache. We found that the patient actually had jolt accentuation of neck pain from CDS and treated her successfully. The characteristic physical finding produced by axial neck rotation in CDS patients is not headache, but a jolt accentuation of neck pain.