Vertebral artery dissection caused by atlantoaxial dislocation: a case report and review of literature
Abstract
Background
Atlantoaxial dislocation (AAD) is the most common craniovertebral junction malformation (CVJm) which are anomalies of the bones and soft tissues surrounding the foramen magnum. It usually leads to neurologic abnormalities because of instability of this mobile area. But vertebral artery dissection (VAD) caused by AAD is uncommon.
Case report
We report a 15-year-old boy who presented with acute onset of bilateral VAD leading to posterior circulation ischemic stroke (PCIS). Computed tomography angiography (CTA) indicated dissection and occlusion of bilateral intracranial vertebral arteries and AAD with os odontoideum. After antithrombotic treatment for 3 months, the patient got complete revascularization and received posterior C1-C2 fusion.
Discussion
There have only been tens of cases of PCIS caused by CVJm. We reviewed these relevant literatures and suggested that more attention should be paid to vascular impairment for patients with CVJm.
Keywords
Atlantoaxial dislocation (AAD) Vertebral artery dissection (VAD) Posterior circulation ischemic stroke (PCIS)Notes
Compliance with ethical standards
Conflict of interest statement
On behalf of all authors, the corresponding author states that there is no conflict of interest.
References
- 1.Ortiz J, Ruland S (2015) Cervicocerebral artery dissection. Curr Opin Cardiol 30:603–610. https://doi.org/10.1097/HCO.0000000000000224 CrossRefGoogle Scholar
- 2.Merwick A, Werring D (2014) Posterior circulation ischaemic stroke. Bmj 348:g3175. https://doi.org/10.1136/bmj.g3175 CrossRefGoogle Scholar
- 3.Schievink WI (2001) Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344:898–906. https://doi.org/10.1056/NEJM200103223441206 CrossRefGoogle Scholar
- 4.Menezes AH, Traynelis VC (2008) Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b). Childs Nerv Syst: ChNS: Off J Int Soc Pediatr Neurosurg 24:1091–1100. https://doi.org/10.1007/s00381-008-0606-8 CrossRefGoogle Scholar
- 5.Chen Z, Jian FZ, Wang K (2012) Diagnosis and treatment of vertebral artery dissection caused by atlantoaxial dislocation. CNS Neurosci Ther 18:876–877. https://doi.org/10.1111/j.1755-5949.2012.00376.x CrossRefGoogle Scholar
- 6.Kulkarni GB, Mustare V, Pruthi N, Pendharkar H, Modi S, Kulkarni A (2014) Profile of patients with craniovertebral junction anomalies with posterior circulation strokes. J Stroke Cerebrovasc Dis: Off J Nat Stroke Assoc 23:2819–2826. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.07.003 CrossRefGoogle Scholar
- 7.Zotter H, Zenz W, Gallistl S, Zohrer B, Lindbichler F (2000) Stroke following appendectomy under general anesthesia in a patient with basilar impression. Acta Anaesthesiol Scand 44:1271–1272CrossRefGoogle Scholar
- 8.Sawlani V, Behari S, Salunke P, Jain VK, Phadke RV (2006) “Stretched loop sign” of the vertebral artery: a predictor of vertebrobasilar insufficiency in atlantoaxial dislocation. Surg Neurol 66:298–304; discussion 304. https://doi.org/10.1016/j.surneu.2006.02.032 CrossRefGoogle Scholar
- 9.Arauz A, Marquez JM, Artigas C, Balderrama J, Orrego H (2010) Recanalization of vertebral artery dissection. Stroke 41:717–721. https://doi.org/10.1161/STROKEAHA.109.568790 CrossRefGoogle Scholar
- 10.Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R (2012) Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:e326S–e350S. https://doi.org/10.1378/chest.11-2298 CrossRefGoogle Scholar
- 11.Bhatnagar M, Sponseller PD, Carroll C, Tolo VT (1991) Pediatric atlantoaxial instability presenting as cerebral and cerebellar infarcts. J Pediatr Orthop 11:103–107CrossRefGoogle Scholar