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Daniel G. Nehls, Stephen R. Marano and Robert F. Spetzler

T ransient ischemic attacks and strokes can occur when a major vessel supplying the brain becomes intermittently occluded. There are numerous reports of intermittent vertebral artery occlusion due to osteophytes, 1 atlantoaxial subluxation, 3 and fibrous bands of the longus colli muscle. 4 Intermittent positional occlusion of a persistent hypoglossal artery has also been implicated in producing transient episodes of syncope. 2 In this paper, we present a case in which angiograms demonstrated occlusion of the internal carotid artery (ICA) when the patient

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Odontoid upward migration in rheumatoid arthritis

An analysis of 45 patients with “cranial settling”

Arnold H. Menezes, John C. VanGilder, Charles R. Clark and George El-Khoury

patients consisted of separation of the anterior arch of the atlas from the clivus. Simultaneous with the downward telescoping of the atlas' anterior arch onto the axis body, the posterior arch of the atlas was displaced rostrally and ventrally, causing a decrease in the anteroposterior diameter of the spinal canal ( Fig. 1 ). In 12 cases, the posterior arch of the atlas protruded into the foramen magnum. Based on flexion-extension lateral cervical spine roentgenograms, there was evidence of atlanto-axial instability in each case, demonstrated by movement of more than 4

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A. Wahab Ibrahim, Mohamed B. Satti and E. Mustafa Ibrahim

on the right side. At a second operation the meningioma was completely removed through an upper cervical laminectomy. The tumor was attached to the dura in the region of the right C-2 nerve root, and lay extradurally with no intradural extension. The dural attachment gave rise to a narrow neck extending posterolaterally into the atlantoaxial ligament, which was thickened and vascular. The tumor expanded into a larger mass which had invaded and occupied the muscles of the right suboccipital region and the apex of the right posterior cervical triangle

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J. Jeffrey Alexander, Seymour Glagov and Christopher K. Zarins

The pathogenesis of vertebral artery injury is related to its anatomical course, with potential compression areas at the transverse foramina of the C-1 through C-6 vertebrae, at the atlanto-occipital joint, and at the atlanto-axial joint, which is the major site of cervical rotation. 13, 14 Furthermore, compression by skeletal muscle and fascial bands can occur at the first portion of the vessel. 5, 6 A reduction in vertebral artery blood flow due to hyperextension, tilting, or rotation of the cervical spine has been well described. 2, 4, 11, 17, 18 In addition

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Cruciate paralysis

Case report

Daniel Dumitru and James E. Lang

only a trace grade of strength while the lower extremities were normal. Lateral cervical spine films with flexion and extension views were normal, and the atlantoaxial region was without fracture or dislocation. By June 13, the patient was completely ambulatory yet had regained only a trace grade of strength in the upper extremities. An additional 3 weeks was required for him to achieve a fair grade of strength in his arms. During this time, he demonstrated voluntary control of tongue musculature. A gag reflex was unobtainable. A feeding jejunostomy was required

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Burke P. Robinson, Joachim F. Seeger and Steven M. Zak

R heumatoid arthritis producing atlantoaxial instability in the cervical spine may lead to neurological symptoms by producing compressive myelopathy 23, 25 or, more rarely, by causing vertebrobasilar insufficiency. 10, 29 To our knowledge, no cases of vertebrobasilar insufficiency associated with cervical rheumatoid arthritis have been documented angiographically. We present a case of bilateral vertebral artery narrowing due to downward subluxation of C-1 on C-2, with further compromise during head extension, and with complete occlusion of the ipsilateral

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John A. Glaser, Richard Whitehill, Warren G. Stamp and John A. Jane

utilizing the orthosis. Based on the initial radiographic studies, upper cervical injuries were diagnosed as Jefferson fractures, atlantoaxial rotatory fixation, traumatic rupture of the atlantoaxial ligaments, odontoid fractures, or hangman's fractures. Lower cervical injuries were categorized as unilateral or bilateral facet dislocations or fracture dislocations, or anterior and posterior spinal column injuries resulting in cervical instability but not facet dislocation. Lateral x-ray films were primarily used to evaluate initial spinal alignment immediately after

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Vincent C. Traynelis, Gary D. Marano, Ralph O. Dunker and Howard H. Kaufman

with respect to the spine. More extensive ligamentous injury may be necessary, however, before atlanto-occipital dislocation occurs. Type I and Type II odontoid fractures would be expected to result in marked weakening or even disruption of the alar ligaments and the tectorial membrane, yet atlanto-occipital dislocation has not been reported to be associated with these lesions. Bohlman, et al. , 5 believed that there is usually complete disruption of all ligamentous structures between the occiput and the atlantoaxial complex. Davis, et al. , 8 reported that

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Joseph M. Bicknell, Wolff M. Kirsch, Robert Seigel and William Orrison

A tlanto-axial dislocation may be congenital, traumatic, or acquired in association with pharyngeal infection or inflammatory joint disease. 6 Although not universally fatal as once believed, it is nonetheless a cause of pain, deformity, and at times serious neurological deficits. Over the years treatment has evolved from bed rest with head stabilization to reduction by traction and/or manipulation and finally to external or internal immobilization. We have recently treated a boy who had atlanto-axial subluxation which followed streptococcal pharyngitis and

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February 1987 66 2 270 275 10.3171/jns.1987.66.2.0270 Feasibility of intracranial surgery in the primate fetus Robert A. Brodner Ronald S. Markowitz Howard J. Lantner February 1987 66 2 276 282 10.3171/jns.1987.66.2.0276 Magnetic resonance images of brain-stem encephalitis Kohkichi Hosoda Norihiko Tamaki Michio Masumura Satoshi Matsumoto February 1987 66 2 283 285 10.3171/jns.1987.66.2.0283 Atlanto-axial dislocation in acute rheumatic fever Joseph M. Bicknell Wolff M. Kirsch Robert Seigel