Acute pseudogout of the neck, also known as the crowned dens syndrome, is a rare cause of neck pain characterised by crystalline deposition in periodontoid articular tissues. It is typified clinically by severe cervical pain and stiffness, often in conjunction with pyrexia and raised inflammatory markers. As such, it is often misdiagnosed. We report 2 cases of crowned dens syndrome masquerading respectively as meningitis and polymyalgia rheumatica, and review the literature with particular attention to the clinical and radiological aspects of this under-recognised condition.