title: Recurrent embolic strokes associated with vertical atlantoaxial subluxation in a patient with rheumatoid arthritis: a case report and review of literature.
abstract: 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.
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Kuroki
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ueno
authors.forename: Ikuko
authors.initials: I
authors.lastname: Takeda
authors.forename: Taiki
authors.initials: T
authors.lastname: Kambe
authors.forename: Kenya
authors.initials: K
authors.lastname: Nishioka
authors.forename: Hideki
authors.initials: H
authors.lastname: Shimura
authors.forename: Masanori
authors.initials: M
authors.lastname: Itoh
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Hattori
authors.forename: Takao
authors.initials: T
authors.lastname: Urabe
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis; D001268:Atlanto-Axial Joint; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D019416:Head Movements; D006439:Hemodynamics; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004204:Joint Dislocations / Q000175:diagnosis / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D012008:Recurrence; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D018616:Ultrasonography, Doppler, Duplex; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000503:physiopathology
keywords: Atlantoaxial subluxation; angiography; carotid duplex ultrasonography; recurrent embolic stroke