Recurrent Embolic Strokes Associated with Vertical Atlantoaxial Subluxation in a Patient with Rheumatoid Arthritis: A Case Report and Review of Literature

We report a 78-year-old woman with rheumatoid arthritis who developed recurrent embolic cerebellar strokes associated with vertical atlantoaxial subluxation (AAS). On contrast angiography, the bilateral vertebral arteries (VAs) were occluded between the C1 and C2 levels, and the distal parts of bilateral VA were supplied by the collateral circulations. Dynamic cerebral angiography and carotid duplex ultrasonography showed that blood flow was substantially decreased in the left VA and left posterior inferior cerebellar artery on cervical anteflexion. It is suggested that vertical AAS reduced the blood flow of collateral circulation in the left VA with cervical anteflexion and might be a cause of recurrent ischemic stroke.

Source: Journal of Stroke and Cerebrovascular Diseases - August 5, 2013 Category: Neurology Authors: Takuma Kuroki, Yuji Ueno, Ikuko Takeda, Taiki Kambe, Kenya Nishioka, Hideki Shimura, Masanori Itoh, Nobutaka Hattori, Takao Urabe Tags: Case Reports Source Type: research