Basilar invagination - rheumatoid arthritis

Case contributed by Senai Goitom Sereke
Diagnosis certain

Presentation

Long standing rheumatoid arthritis.

Patient Data

Age: 65 years
Gender: Female
This study is a stack
Sagittal
T2
This study is a stack
Coronal
STIR
This study is a stack
Sagittal
T1
This study is a stack
Sagittal
STIR
This study is a stack
Axial
T1
This study is a stack
Axial
T2
This study is a stack
Axial 3D
COSMIC
This study is a stack
Sagittal T1
C+ fat sat
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Info

Cranial settling with anteroposterior subluxation of the atlantoaxial joint is demonstrated, as the odontoid process projects superoposteriorly, with the tip of the odontoid process at the same level as the basion. There is a widening of the atlantodental interval (~8 mm). Focal impression on the corticomedullary junction is observed due to the posteriorly displaced C2, resulting in a focal loss of the anterior arachnoid space, but without compressive myelopathy. Erosive changes are noted in the odontoid process, along with pannus formation in the atlantoaxial joint.

Case Discussion

Rheumatoid arthritis is an acquired cause of basilar invagination. Basilar invagination can manifest in isolation or with atlantoaxial subluxation or dislocation, leading to significant instability. The term "cranial settling" is used to appropriately describe basilar invagination in rheumatoid arthritis.

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