INTRODUCTION The course of the vertebral artery after exiting from the C1 foramen transversarium and prior to entering the dura lends itself to compression in C1-2 instability. However, atlantoaxial dislocation presenting with vertebrobasilar insufficiency and posterior circulation stroke (PCS) is rare. METHODS In this retrospective study, we identified 96 patients with PCS who had complete radiological data. Ten (10.4%) patients had craniovertebral junction (CVJ) anomalies, of which six underwent surgery and four were managed conservatively. The clinical and functional outcomes were measured in the two groups. RESULTS Left-sided strokes were seen in 7/10 patients, the majority of whom had left dominant vertebral arteries. The mean age at presentation in those with CVJ anomalies was 27.2 ± 12.8 years that was significantly lower than those without CVJ anomalies, 52.2 ± 14.5 years (p ≤ 0.001). The etiologies of PCS in those < 50 years were CVJ anomalies (30%), atherosclerosis (30%) and vasculitis (27%); however, the overwhelming majority of strokes in the > 50 year age group was atherosclerosis (91%). Postoperatively, there were no recurrent strokes in the operated patients, who also obtained significant clinical improvement on the modified Rankin Scale, Nurick Scale and modified McCormick Scale as compared to those who did not undergo surgery. CONCLUSION Early diagnosis and surgical treatment of CVJ instability prevent recurrent strokes and improve outcomes in patients with PCS. Physicians and spine surgeons need to be sensitized regarding CVJ anomalies as a cause of PCS enabling early diagnosis with dynamic imaging particularly in the younger age group. These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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后循环卒中患者必须进行颅脑交界处的动态成像。

引言椎动脉从C1椎间孔横穿后进入硬脑膜的过程使C1-2不稳定。然而，伴有椎基底动脉供血不足和后循环卒中（PCS）的寰枢椎脱位很少见。方法在这项回顾性研究中，我们确定了96例具有完整放射学资料的PCS患者。十名（10.4％）的患者存在颅椎交界处（CVJ）异常，其中六名接受了手术，四名接受了保守治疗。在两组中评估了临床和功能结局。结果在7/10例患者中出现了左侧中风，其中大多数患者有左椎支。CVJ异常患者的平均出现年龄为27.2±12。8年显着低于无CVJ异常的8年，即52.2±14.5年（p≤0.001）。在<50年的时间里，PCS的病因是CVJ异常（30％），动脉粥样硬化（30％）和血管炎（27％）。但是，> 50岁年龄组的绝大多数卒中是动脉粥样硬化（91％）。术后没有手术复发的患者，与未进行手术的患者相比，改良的兰金量表，纽里克量表和改良的麦考密克量表在临床上也有明显改善。结论CVJ不稳定性的早期诊断和外科治疗可预防PCS患者复发性中风并改善预后。对于CVJ异常是PCS的原因，需要对内科医生和脊柱外科医生敏感，尤其是在较年轻的年龄组中，可以通过动态成像进行早期诊断。这些幻灯片可以在电子补充材料下找到。