Two cases of multiple infarctions due to vertebral arterial occlusion associated with atlantoaxial subluxation caused by rheumatoid arthritis

DOI IR HANDLE
  • Baba Hideo
    Department of orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Tateishi Yohei
    Cerebrovascular Center, Nagasaki University Hospital
  • Tagami Atsushi
    Department of orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Tsuda Keiichi
    Department of orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Yoda Itaru
    Department of orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Koseki Hironori
    Department of orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Tomita Masato
    Department of orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Kawakami Atsushi
    Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • Osaki Makoto
    Department of orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences

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Abstract

Case 1: A 58-year-old woman with rheumatoid arthritis (RA) suffered from pontine and cerebellar infarctions and underwent three-dimensional computed tomography angiography (3D-CTA) of the vertebral artery (VA) with left-sided rotation of the head. This revealed a destroyed right atlantoaxial (AA) joint and right VA occlusion, which had caused the infarction. No recurrent infarctions have been observed after transarticular screw fixation (Magerl technique) was performed. Case 2: A 68-yearold woman with RA also suffered from pontine and cerebellar infarctions and underwent 3D-CTA of the VA with right-sided rotation of the head. This revealed a destroyed left AA joint and left VA occlusion, which had caused the infarction. No recurrent infarctions have been observed after posterior fusion between the occiput and 3rd cervical vertebra was performed. 　In both cases of RA, who had multiple infarctions due to VA occlusion and a temporary thrombus formation, 3D-CTA in a rotated position helped to diagnose arterial occlusion. In addition, posterior fusion of the AA joint was a useful surgical technique.

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