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Multiple Infarctions Due to Vertebral Arterial Occlusion Associated with Atlantoaxial Subluxation in Patients with Rheumatoid Arthritis: A Case Report

Yamada T, Yoshii T*, Egawa S, Hirai T, Inose H and Okawa A

Rheumatoid Arthritis (RA) is associated with a high incidence of destruction of multiple joints, including Atlantoaxial Subluxation (AAS). Because the Vertebral Arteries (VA) is near the Atlantoaxial (AA) joint, VA occlusion may occur due to AAS. Since the VA supplies blood to the cerebellum and brainstem, serious symptoms can develop if infarction occurs due to VA occlusion. In this case report of a 64-year-old female RA patient, CT angiography demonstrated a dissecting aneurysm and the occlusion of the left VA at the AA joint, attributed to the one-sided destruction of the C1/C2 lateral mass, leading to frequent cerebellum infarctions. Vertigo and neck pain in the extension position disappeared after C1/C2 posterior fixation, and infarctions originating from VA occlusion never recurred after surgery. As the positional occlusion of VA in AAS itself has become relatively uncommon since the use of biological preparations for RA treatment, the authors describe a case in which C1/C2 fixation is effective for preventing neck pain, deterioration of neurological findings and the recurrence of cerebellum infarctions due to positional VA occlusion.