Multiple cerebellar infarction due to vertebral artery obstruction and bulbar symptoms associated with vertical subluxation and atlanto-occipital subluxation in ankylosing spondylitis.
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.
Shim
S C
SC
The Hospital for Rheumatic Diseases, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Yoo
D H
DH
Lee
J K
JK
Koh
H K
HK
Lee
S R
SR
Oh
S H
SH
Kim
S Y
SY
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*