Brain Stem Compression in Rheumatoid Arthritis

INVOLVEMENT of the cervical spine, particularly the atlanto-axial (C-1 to C-2) area, by rheumatoid arthritis (RA) may result in serious complications, including quadraparesis, vertebral artery insufficiency, and death.1Pathologic conditions of the cervical spine are common in RA and may occur in as many as 86% of patients with this disease.1The incidence of roentgenographic evidence of serious C-1 to C-2 subluxations has been reported as high as 25%.1The present report describes an unusual patient with spinal cord and medullary compression caused by rheumatoid involvement of these two vertebrals and reviews the diagnosis and treatment of this potentially reversible but frequently overlooked complication. Report of a Case A 59-year-old woman was in good health until 1964, when RA developed. Over the ensuing ten years, she suffered from progressive disease, with subluxation of metatarsal and metaphalangeal joints, ulnar deviation of the fingers, swan neck and butonniere deformities,