Rheumatoid arthritis and positional vertebrobasilar insufficiency

Case report

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✓ The authors report a case of positional occlusions of the vertebral arteries in a 45-year-old patient with juvenile rheumatoid arthritis. The occlusions were documented angiographically by placing the head in various positions during digital subtraction angiography using aortic arch injections.

Article Information

Address reprint requests to: Joachim F. Seeger, M.D., Department of Radiology, Room 1541, University of Arizona Health Sciences Center, College of Medicine, Tucson, Arizona 85724.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Midline sagittal tomogram showing upward telescoping of C-2 into C-1, and mild displacement of the tip of the odontoid process (arrows) through the foramen magnum (asterisks). Right: Sagittal tomogram 1.5 cm to the left of the midline showing old erosive changes of the C1–2 facet joint with secondary hypertrophic degenerative spurring (short arrows), adjacent to where the left vertebral artery exits the foramen transversarium of C-2 (curved arrow). Similar changes were present on the right.

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    Left: Anteroposterior view of a digital arch aortogram with the head turned to the right shows good opacification of a large left vertebral artery (arrows) but no filling of the right, the origin of which is defined by the asterisk. Center: During a second injection, with imaging centered higher in the neck and with the head turned to the left, the right vertebral artery is opacified (open arrows) but the left no longer fills. Right: Film obtained 2 seconds later (using a later mask for subtraction) showing opacification of the distal right vertebral (open arrow) and basilar (arrowheads) arteries but still no filling of the left vertebral artery.

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