Vol.22 No.4

Case Report

Positional occlusion of the vertebral artery in a case of rheumatoid atlantoaxial subluxation presenting with multiple cerebral and cerebellar infarction

Authors

Hiroyasu Fujiwara1 , Takashi Kaito1 , Takahiro Makino1 , Kazuo Yonenobu1

  • Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
Received:

2 August 2011

Accepted:

29 September 2011

Published online:

18 October 2011

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Abstract

We report an uncommon case of positional occlusion of the vertebral artery associated with rheumatoid arthritis (RA). Plain radiography showed reducible atlantoaxial subluxation, and dynamic vertebral arteriography demonstrated positional occlusion of the left vertebral artery. The patient was treated with C1-2 posterior fusion and has since experienced no recurrent symptoms. Insufficiency of the vertebrobasilar artery is a relatively uncommon complication with cervical lesions in RA patients. However, when RA patients manifest recurrent cerebral and cerebellar symptoms, this condition should be kept in mind and actions taken to avoid further irreversible cerebral damage. Recommended imaging methods include vertebral dynamic lateral plain radiography of the cervical spine and vertebral arteriography at multiple cervical positions.

Key words

Atlantoaxial subluxation - Vertebral artery - Positional occlusion - Rheumatoid arthritis - Vertebral arteriography