Basilar invagination presenting as recurrent posterior circulation stroke with locked-in syndrome in a child: a case report

2017 ◽  
Vol 5 (1) ◽  
pp. 271
Author(s):  
Mukesh Kumar ◽  
Pooja Mehta ◽  
Pawan K. Garg
Keyword(s):  
Case Report ◽  
Cranial Nerves ◽  
Young Patients ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Posterior Circulation ◽  
Cervical Cord ◽  
Stroke Treatment ◽  
Posterior Circulation Stroke

Basilar invagination is a type of craniovertebral junction anomaly which occurs when the tip of odontoid process migrates upward into the intracranial space through foramen magnum and most commonly present as progressive neurological deficit implicating the high cervical cord, lower brainstem and cranial nerves. It can rarely present as vertebro-basilar territory insufficiency and occlusion, leading to stroke. Treatment is typically surgical and continues to centre on varying combinations of anterior or posterior decompression with or without traction or fusion. We present a 13-year-old boy with basilar invagination diagnosed on MRI with angiogram, which was missed on initial presentation, leading to recurrent posterior circulation stroke progressed to Locked-in syndrome. This case report emphasis the need of screening for craniovertebral junction anomalies in young patients presenting with posterior circulation stroke.

Republished: Congenital anomaly of the posterior arch of the atlas: a rare risk factor for posterior circulation stroke

2017 ◽  
Vol 9 (7) ◽  
pp. e27-e27 ◽  
Author(s):  
Zhi-yuan Ouyang ◽  
Min-jian Qiu ◽  
Zhe Zhao ◽  
Xiao-bing Wu ◽  
Lu-sha Tong
Keyword(s):  
Vertebral Artery Dissection ◽  
Young Patients ◽  
Craniovertebral Junction ◽  
Posterior Circulation ◽  
Atlantoaxial Instability ◽  
Artery Dissection ◽  
Posterior Arch ◽  
Atlantoaxial Joint ◽  
Posterior Circulation Stroke ◽  
First Case

We report an extremely rare case involving a posterior arch anomaly of the atlas, causing a vertebral artery dissection (VAD) induced posterior circulation stroke. A 16-year-old girl was admitted to hospital because of new onset dizziness. VAD related multiple infarction in the posterior circulation was revealed. The congenital posterior arch anomaly of the atlas, along with instability of the atlantoaxial joint, were discovered accidentally during follow-up. This is the first case of ischemic stroke related to atlantal posterior arch aplasia and atlantoaxial instability. Although rare, it reminds us that investigation of the craniovertebral junction should be considered when stroke occurs in young patients.

APICAL PLEURAL ASPERGILLOSIS WITH PANCOAST'S SYNDROME AND POSTERIOR CIRCULATION STROKE: A CASE REPORT

2021 ◽  
pp. 101154
Author(s):  
Y Muralidhar Reddy ◽  
Subhendu Parida ◽  
Premchand Gupta ◽  
Shyam K Jaiswal ◽  
Ganjisreenivasa Gnaneswar ◽  
...  
Keyword(s):  
Case Report ◽  
Posterior Circulation ◽  
Posterior Circulation Stroke

scholarly journals Transoral intraarticular cage distraction and C-JAWS fixation for revision of basilar invagination with irreducible atlantoaxial dislocation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaobao Zou ◽  
Binbin Wang ◽  
Haozhi Yang ◽  
Su Ge ◽  
Bieping Ouyang ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Odontoid Process ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Atlantoaxial Instability ◽  
Cervical Cord ◽  
Atlantoaxial Joint ◽  
Japanese Orthopedic Association ◽  
Satisfactory Outcome ◽  
Irreducible Atlantoaxial Dislocation

Abstract Background The revision surgery of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) after a previous occipitocervical fusion (OCF) is challenging. Transoral revision surgery has more advantages than a combined anterior and posterior approach in addressing this pathology. The C-JAWS is a cervical compressive staple that has been used in the lower cervical spine with many advantages. Up to now, there is no report on the application of C-JAWS in the atlantoaxial joint. We therefore present this report to investigate the clinical outcomes of transoral intraarticular cage distraction and C-JAWS fixation for revision of BI with IAAD. Methods From June 2011 to June 2015, 9 patients with BI and IAAD were revised by this technique after previous posterior OCF in our department. Plain cervical radiographs, computed tomographic scans and magnetic resonance imaging were obtained pre- and postoperatively to assess the degree of atlantoaxial dislocation and compression of the cervical cord. The Japanese Orthopedic Association (JOA) score was used to evaluate the neurological function. Results The revision surgeries were successfully performed in all patients. The average follow-up duration was 18.9 ± 7.3 months (range 9–30 months). The postoperative atlas-dens interval (ADI), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and JOA score were significantly improved in all patients (P < 0.05). Bony fusion was achieved after 3–9 months in all cases. No patients developed recurrent atlantoaxial instability. Conclusions Transoral revision surgery by intraarticular cage distraction and C-JAWS fixation could provide a satisfactory outcome for BI with IAAD after a previous unsuccessful posterior operation.

scholarly journals Simultaneous anterior and posterior circulation stroke secondary to large-vessel atherosclerotic disease associated with persistent trigeminal artery: a case report

2021 ◽  
Author(s):  
Fernando Benevides Falcão ◽  
Guilherme Diogo Silva ◽  
Cesar Castello Branco Lopes ◽  
Aston Marques Midon ◽  
Carlos André Oshiro
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Posterior Circulation ◽  
Large Vessel ◽  
Persistent Trigeminal Artery ◽  
Trigeminal Artery ◽  
Posterior Circulation Stroke ◽  
Increased Risk

Context: Cardioembolic events are the main cause of simultaneous anterior and posterior circulation stroke. Anatomical variants of the circle of Willis represent another rare mecanism. Persistent trigeminal artery is a carotid–vertebrobasilar anastomosis related to an increased risk of aneurysms, vascular malformations and stroke. Case report: A 67-year-old diabetic man was brought to the emergency department with a history of sudden onset of left hemiparesis. Neurologic finginds showed a hemiparesis, hemianesthesia and heminegligence (all left sided), right hemiataxia and a dysarthria. Brain Magnetic Resonance study revealed a isquemic stroke in right middle cerebral artery, right posterior cerebral artery (PCA) and bilateral superior cerebellar arteries (SUCA). Computed tomography angiography showed a right internal carotid artery oclusion and a persistent trigeminal artery. Causitive Classification System (CCS) revealed a large-vessel atherosclerotic stroke. A non-habitual simultaneous affection of PCA and SUCA resulted from a carotid artery embolization associated with anterior and posterior territories anostomosis by the persistent trigeminal artery. Secondary prevention consisted of aspirin 100mg/day and cardiovascular risk factor control. The patient remained free from others cardiovascular events, in rehabilitation, at the moment, in category 3 from the Ranking Modified Scale. Conclusions: The presence of a persistent trigeminal artery, in the context of a internal carotid oclusion, can chance our stroke-mecanism interpretation. Simultaneous anterior and posterior circulation stroke are compatible with large-vessel aterosclerotic disease.

scholarly journals Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior compression

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Xingwen Wang ◽  
Longbing Ma ◽  
Zhenlei Liu ◽  
Zan Chen ◽  
Hao Wu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Intraoperative Ct ◽  
Image Guided ◽  
Transoral Odontoidectomy ◽  
Accurate Localization ◽  
Indirect Decompression ◽  
Challenging Situation

Abstract Background Although the single-stage posterior realignment craniovertebral junction (CVJ) surgery could treat most of the basilar invagination (BI) and atlantoaxial dislocation (AAD), there are still some cases with incomplete decompression of the spinal cord, which remains a technique challenging situation. Methods Eleven patients were included with remained myelopathic symptoms after posterior correction due to incomplete decompression of the spinal cord. Transoral odontoidectomy assisted by image-guided navigation and intraoperative CT was performed. Clinical assessment and image measurements were performed preoperatively and at the most recent follow-up. Results Eleven patients were followed up for an average of 47 months. Symptoms were alleviated in 10 of 11 patients (90.9%). One patient died of an unknown reason 1 week after the transoral approach. The clinical and radiological parameters pre- and postoperatively were reported. Conclusion Transoral odontoidectomy as a salvage surgery is safe and effective for properly selected BI and AAD patients after inadequate indirect decompression from posterior distraction and fixation. Image-guided navigation and intraoperative CT can provide precise information and accurate localization during operation, thus enabling complete resection of the odontoid process and decompression of the spinal cord.

Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation

2004 ◽  
Vol 1 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Atul Goel
Keyword(s):  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Atlantoaxial Joint ◽  
Lateral Mass ◽  
Content Type ◽  
Joint Distraction ◽  
History Of ◽  
Fine Print

Object. The author discusses the successful preliminary experience of treating selected cases of basilar invagination by performing atlantoaxial joint distraction, reduction of the basilar invagination, and direct lateral mass atlantoaxial plate/screw fixation. Methods. Twenty-two patients with basilar invagination—in which the odontoid process invaginated into the foramen magnum and the tip of the odontoid process was above the Chamberlain, McRae foramen magnum, and Wackenheim clival lines—were selected to undergo surgery. In all patients fixed atlantoaxial dislocations were documented. The 16 male and six female patients ranged in age from 8 to 50 years. A history of trauma prior to the onset of symptoms was documented in 17 patients. Following surgery, the author observed minimal-to-significant reduction of basilar invagination and alteration in other craniospinal parameters resulting in restoration of alignment of the tip of the odontoid process and the clivus and the entire craniovertebral junction in all patients. In addition to neurological and radiological improvement, preoperative symptoms of torticollis resolved significantly in all patients. The minimum follow-up period was 12 months and the mean was 28 months. Conclusions. Joint distraction and firm lateral mass fixation in selected cases of basilar invagination is a reasonable surgical treatment for reducing the basilar invagination, restoring craniospinal alignment, and establishing fixation of the atlantoaxial joint.

The New FA₂ST Stroke Screening Score: An Expanding Recognition to Posterior Circulation Stroke

2021 ◽  
Vol 104 (7) ◽  
pp. 1132-1139
Keyword(s):  
Acute Stroke ◽  
Diagnostic Performance ◽  
Area Under The Curve ◽  
Posterior Circulation ◽  
Rapid Screening ◽  
Cross Sectional ◽  
Stroke Treatment ◽  
Posterior Circulation Stroke ◽  
Keywords Screening ◽  
Depth Analysis

Background: Rapid screening and intervention are the keys to successful early treatment of stroke. Generally, the conventional FAST stroke screening score has been used by triage nurses to promptly detect acute stroke. However, the conventional FAST score has a limitation in detecting posterior circulation stroke, which results in high mortality rates. Previous studies have shown that adding ataxia could increase the sensitivity of posterior circulation stroke detection. Objective: To introduce and evaluate the diagnostic performance of a new stroke screening score, FA₂ST score, by adding ataxia to the conventional FAST score. Materials and Methods: The present study was a cross-sectional study. The new FA₂ST and conventional FAST scores were used by triage nurses in patients presented with acute neurological symptoms within seven days at the emergency department of three different types of hospitals in Thailand. Patients with Glasgow Coma Score less than 9 and those having unstable vital signs were excluded. Final diagnosis was made by a neurologist using clinical and neuroimaging information. The diagnostic performance of the new FA₂ST score was calculated using ROC curve in comparison to the conventional FAST score. The rate of posterior circulation stroke detection was calculated as percentage. Results: One hundred forty-six patients were studied. Of these, 127 (86%) had acute ischemic stroke and 19 (14%) had other diagnoses. The overall diagnostic performance of the new FA₂ST score was not statistically different with conventional FAST score in terms of area under the curve (0.642 versus 0.684, p=0.221). However, after in-depth analysis, the rate of posterior circulation stroke detection of the new FA₂ST score was higher compared with the conventional FAST score (94.12% versus 82.35%). Conclusion: The present study introduces the new FA₂ST stroke screening score and emphasizes the importance of posterior circulation stroke detection in acute stroke screening. Future studies should be considered before implementation of this score. Keywords: Screening score; Acute stroke treatment; Stroke; Emergency neurology

scholarly journals Posterior circulation stroke mimicking a pontomedullary brain stem lesion: A case report

2019 ◽  
Vol 18 ◽  
pp. 100491
Author(s):  
Abiodun Idowu Okunlola ◽  
Paul Olowoyo ◽  
Cecilia Kehinde Okunlola ◽  
Olakunle Fatai Babalola
Keyword(s):  
Case Report ◽  
Brain Stem ◽  
Posterior Circulation ◽  
Posterior Circulation Stroke ◽  
Brain Stem Lesion ◽  
Stem Lesion
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