His history was also remarkable for congenital microcephaly, short stature, congenital cataracts, cleft palate, ventricular septal defect, atlantoaxial subluxation
, cryptorchidism, and sensorineural hearing loss.
Risks of general anaesthesia include the difficulties of tracheal intubation and the potential complications encountered in vascular EDS patients (i.e., arterial dissection/cerebral hemorrhage during hypertensive response to intubation, possible pneumothorax from positive pressure ventilation, and unstable cervical spine with potential for atlantoaxial subluxation
) [3, 7, 8].
The ossicle was associated with an atlantoaxial subluxation
and with the posterior wall of 14 mm on spinal canal (Figures 1(e) and 1(f), white lines) that has increased since a previous CT 8 years ago.
Different pathophysiologies have been described including KD associated with Grisel's syndrome, a rare, nontraumatic atlantoaxial subluxation
; KD with retropharyngeal edema and arthritis of the small joints in the head and neck region ; and KD with severe cervical spine and bilateral temporomandibular joint arthritis .
Due to erosions of the transverse, the apical, and the alar ligaments, anterior atlantoaxial subluxation
and spinal cord compression especially in the upper cervical region are frequently noted.
The common neurological complications of rheumatoid arthritis are peripheral neuropathies, such as carpal tunnel syndrome and myelopathy due to atlantoaxial subluxation
. It is very rare to find complications involving pathologies inside the cranium.
In another rare situation, fusion of the lower cervical spine in DISH is possibly associated with enhanced mechanical stress at the craniocervical region, which could lead to soft tissue mass, odontoid fracture, atlantoaxial subluxation
, and pseudotumor and then cause severe spinal cord lesion.[sup] In the current case, there was no obvious spinal stenosis or craniocervical abnormality.
[1,2] Anterior atlantoaxial subluxation
and atlantoaxial impaction are the most characteristic cervical spine disease in RA, occurring in 13-70% and 4-35% of patients, respectively, worldwide.
Dewar, "Rotary fixation of the atlantoaxial joint: rotational atlantoaxial subluxation
," Radiology, vol.
Anterior atlantoaxial subluxation
is characterized by a radiographic distance of more than 3 mm between the anterior aspect of the dens and the posterior aspect of the anterior arch of the atlas.