J Korean Neurol Assoc > Volume 17(6); 1999 > Article
Journal of the Korean Neurological Association 1999;17(6): 841-847.
류마티스성 환축추 아탈구의 신경학적 소견
고성호, 김승현 김주한 김명호
한양대학교 의과대학 신경과학교실
Neurologic Manifestations of Atlanto-axial Subluxation in the Patients with Rheumatoid Arthritis
Seong-Ho Koh, M.D., Seung-Hyun Kim, M.D., Juhan Kim, M.D., Myung-Ho Kim, M.D.
Department of Neurology, College of Medicine, Hanyang University
Abstract
Background : Atlanto-axial dislocation (AAD) is a common complication of rheumatoid arthritis (RA). Diverse or different patterns of neurological manifestations including brainstem signs, myelopathy, vertebrobasilar insufficiency, and radiculopathy are expected in each type of AAD. This study is designed for the evaluation of neurological manifes-tations of AAD in RA, and for the comparison of clinical profiles with radiological findings. Methods : Thirty patients compatible with radiological criteria of AAD were selected. The age, sex, symptom duration, and neurological signs were evaluated in the clinical profiles. Based on the neurological signs, the patients were classified into three groups. Radiological classifications of AAD were done according to the direction of AAD (anterior, vertical, lateral, mixed) and degrees of dislocation (grade I, II, III). Correlational analysis was performed as a measure of association with the clinical profiles and radiological findings. R e s u l t s : Neurological manifestations were present/found in 50% of the patients. Each types of AAD were distributed into the following groups:; anterior - 76.7%, mixed - 13.3%, lateral -10%, pure vertical - 0% in our study. The various groups determined by the neurological signs may be correlated with the severity of AAD, especially in the anterior type (> 8mm) and mixed type. Neurological signs were not noted in the pure lateral type. Vascular signs such as vertebrobasilar insufficiency (VBI) were more common in the anterior-AAD, but myelopathic or brainstem signs were more common in the mixed type. Conclusions : Diverse neurological findings exist in AAD. Different and characteristic manifestations are also noted in each type of AAD. Critical neurological signs including myelopathic, brainstem signs and VBI are prominent in severe anterior-AAD or mixed type. J Korean Neurol Assoc 17(6):841~847, 1999 Key Words : Atlanto-axial dislocation, Neurologic manifestation, Rheumatoid arthritis


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