Pediatric Cerebellar Infarction Caused by Atlantoaxial Subluxation —Case Report—

Abstract

An 11-year-old girl developed cerebellar infarction presenting as a posterior fossa mass lesion after stretching and flexing her neck. Cerebral angiography demonstrated irregular narrowing of the right vertebral artery at the C2 level and x-rays of the upper cervical spine showed atlantoaxial subluxation with os odontoideum. She underwent surgical decompression with removal of infarcted tissue. The cerebellar infarction probably resulted from occlusion of the vertebral artery, followed by brain swelling due to recanalization.

Recurrent cerebral embolism in a young adult with Down?s syndrome

“…To our knowledge, there have been no previous reports of patients with DS associated with infarction caused by atlantoaxial dislocation. Stroke due to atlantoaxial dislocation has been observed in a few cases, most of which were caused by cervical spine trauma [8,9] and rarely by ankylosing spondylitis [14] or cranio-cervical anomalies [1]. In a retrospective review of cineangiography of patients with DS, 40 % of patients had an aberrant origin of the left vertebral artery from the aortic arch [13].…”

Vertebral Artery Dissection in the Setting of Unstable Os Odontoideum

“…There are reported pediatric cases of neurologic deficits in the setting of unstable os odontoideum [5][6][7][8] . Miyata et al reported a case of cerebellar infarction in an 11-year-old girl with os odontoideum after flexing and extending her neck 6 .…”

Os Odontoideum: Review Article

“…99 Two more cases were reported in 1994 and 2003 by Miyata et al and Fukuda et al, respectively. 100, 101 Takakuwa et al reported intermittent vertebral artery kinking due to OO in 2 out of 7 patients with craniovertebral anomalies, who suffered from posterior circulation attacks due to asymptomatic OO. 99,[101][102][103] In addition to the above mentioned clinical symptoms, sleep apnea rarely is observed among patients suffering from OO with an anterior atlantoaxial subluxation.…”