title: Multiple cerebellar infarction due to vertebral artery obstruction and bulbar symptoms associated with vertical subluxation and atlanto-occipital subluxation in ankylosing spondylitis.
abstract: Ankylosing spondylitis (AS) results in disease-specific inflammation at the site of ligamentous insertion into the bone. Atlantoaxial joint subluxation and vertical subluxation of the axis may occur as a consequence of instability resulting from the inflammatory process. Spontaneous anterior atlantoaxial subluxation is a well recognized complication in about 2% of patients with AS, and presents with or without signs of spinal cord compression. Vertical subluxation may follow anterior or posterior subluxation. It was noted in 3-8% of patients with rheumatoid arthritis, but is an exceedingly rare complication of AS. Moreover, it has never been reported that multiple cerebellar infarction and bulbar symptoms developed spontaneously due to atlanto-occipital subluxation and vertical subluxation in a patient with a long [corrected] history of AS. We describe a man with AS who developed multiple cerebellar infarction due to vertebral artery obstruction and bulbar symptoms associated with atlanto-occipital subluxation and vertical subluxation.
authors.affiliation: The Hospital for Rheumatic Diseases, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: S C
authors.initials: SC
authors.lastname: Shim
authors.forename: D H
authors.initials: DH
authors.lastname: Yoo
authors.forename: J K
authors.initials: JK
authors.lastname: Lee
authors.forename: H K
authors.initials: HK
authors.lastname: Koh
authors.forename: S R
authors.initials: SR
authors.lastname: Lee
authors.forename: S H
authors.initials: SH
authors.lastname: Oh
authors.forename: S Y
authors.initials: SY
authors.lastname: Kim
mesh_terms: D001157:Arterial Occlusive Diseases / Q000150:complications / Q000473:pathology; D001268:Atlanto-Axial Joint / Q000473:pathology; D001269:Atlanto-Occipital Joint / Q000473:pathology; D010244:Bulbar Palsy, Progressive / Q000150:complications* / Q000473:pathology; D002544:Cerebral Infarction / Q000209:etiology* / Q000473:pathology; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000473:pathology; D007596:Joints / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013167:Spondylitis, Ankylosing / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D014711:Vertebral Artery / Q000473:pathology*