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

Authors
Journal
Journal of Stroke and Cerebrovascular Diseases
1052-3057
Publisher
Elsevier
Volume
22
Issue
8
Identifiers
DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.010
Keywords
  • Atlantoaxial Subluxation
  • Recurrent Embolic Stroke
  • Angiography
  • Carotid Duplex Ultrasonography

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.

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