Rheumatoid arthritis-induced lateral atlantoaxial subluxation with multiple vertebrobasilar infarctions.
Rheumatoid arthritis-induced lateral atlantoaxial subluxation with multiple vertebrobasilar infarctions.
复制标题
类风湿性关节炎引起的寰枢椎外侧半脱位伴多发性椎基底动脉梗死。
DOI：
10.1097/brs.0000000000000701
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Nakase H.
中科院分区：
文献类型：
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作者：
Takeshima Y;Matsuda R;Hironaka Y;Motoyama Y;Nakase H.
研究设计.病例报告.目的：强调类风湿性关节炎(RA)患者存在侧方环枢椎半脱位(AAS)并导致椎基底动脉梗死的可能性。背景资料摘要：虽然侧方半脱位是AAS的一个众所周知的亚型，但与侧方AAS相关的脑缺血病例尚未见报道。方法：一位52岁男性，有6年的类风湿关节炎病史，突然出现视野缺陷和轻度右侧小脑共济失调。头部磁共振成像显示椎基底动脉区域急性多发性梗塞，磁共振血管成像显示左侧椎动脉(VA)狭窄。中立位颈椎侧位X线片显示寰枕融合，前路AAS。颈椎磁共振成像的T2加权矢状面图像显示脊髓在C1-C2处有高信号。脑血管造影显示右侧VA闭塞，左侧VA V3段严重狭窄。颅颈交界处的三维CT血管成像显示侧方AAS，这是由于小关节严重的侵蚀改变，左侧V3部分被骨性成分狭窄。结果：两个月后，患者接受了枕颈后路植骨融合术。术后病程平稳，左侧VA狭窄消失。在45个月的随访中，他没有进一步的梗塞。放射学证实骨融合，三维CT血管成像显示受影响的左侧VA通畅良好。结论：RA患者存在AAS的潜在危险。尤其是在疾病的晚期，侧方AAS可通过位置性VA闭塞而诱发脑缺血。证据水平：N/AA，52岁男性，经历了复发性椎基底动脉梗死，并被诊断为侧方枢椎半脱位(AAS)所致的位置性椎动脉闭塞。进行了后路融合术，没有发生进一步的梗塞。在类风湿关节炎患者中，应考虑侧方AAS的风险，因为它可能导致脑缺血。
Study Design.Case report.Objective.To highlight the probability that lateral atlantoaxial subluxation (AAS) exists in patients with rheumatoid arthritis (RA) and induces vertebrobasilar infarctions that are more foregrounded than compressive myelopathy.Summary of Background Data.Although lateral subluxation is a well-known subtype of AAS, a case of cerebral ischemia associated with lateral AAS has not been reported before.Methods.A 52-year-old male with a 6-year history of RA had a sudden onset of visual field defect and mild right cerebellar ataxia. Head magnetic resonance imaging revealed acute multiple infarctions in the vertebrobasilar area, and magnetic resonance angiography revealed stenosis of the left vertebral artery (VA). Lateral radiograph of the cervical spine in the neutral position revealed atlanto-occipital assimilation and anterior AAS. T2-weighted sagittal images on cervical magnetic resonance imaging revealed high signal intensity in the spinal cord at C1–C2. Cerebral angiography revealed right VA occlusion and severe stenosis of the left V3 segment of VA. Three-dimensional computed tomography angiography of the craniovertebral junction revealed lateral AAS, which was due to severe erosive changes of the facet joints, and the left V3 portion was stenosed by a bony component. During conservative therapy, the patient experienced left occulomotor nerve palsy due to a second stroke.Results.Two months later, the patient underwent occipitocervical posterior fusion with an iliac bone graft. His postoperative course was uneventful, and the left VA stenosis disappeared. At the 45-month follow-up, he had no further infarctions. Bony fusion was radiologically confirmed, and 3-dimensional computed tomography angiography revealed good patency of the affected left VA.Conclusion.In patients with RA, the potential risk of AAS should be recognized. Lateral AAS in particular may induce cerebral ischemia by positional VA occlusion in advanced stages of the disease.Level of Evidence: N/AA 52-year-old male experienced recurrent vertebrobasilar infarctions and received a diagnosis of positional vertebral artery occlusion induced by lateral atlantoaxial subluxation (AAS). Posterior fusion was performed, and no further infarctions occurred. In patients with rheumatoid arthritis, the risk of lateral AAS should be considered because it may cause cerebral ischemia.