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Case report
Republished: Congenital anomaly of the posterior arch of the atlas: a rare risk factor for posterior circulation stroke
  1. Zhi-yuan Ouyang1,
  2. Min-jian Qiu1,
  3. Zhe Zhao2,
  4. Xiao-bing Wu3,
  5. Lu-sha Tong1
  1. 1The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
  2. 2Department of Orthopedics, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
  3. 3The Second People Hospital of Quzhou, Quzhou, China
  1. Correspondence to Dr Lu-sha Tong, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; rosa00tong{at}


We report an extremely rare case involving a posterior arch anomaly of the atlas, causing a vertebral artery dissection (VAD) induced posterior circulation stroke. A 16-year-old girl was admitted to hospital because of new onset dizziness. VAD related multiple infarction in the posterior circulation was revealed. The congenital posterior arch anomaly of the atlas, along with instability of the atlantoaxial joint, were discovered accidentally during follow-up. This is the first case of ischemic stroke related to atlantal posterior arch aplasia and atlantoaxial instability. Although rare, it reminds us that investigation of the craniovertebral junction should be considered when stroke occurs in young patients.

  • Aneurysm
  • Congenital
  • Cervical
  • Dissection
  • Malformation

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  • Republished with permission from BMJ Case Reports Published 4 January 2017; doi:10.1136/bcr-2016-012731

  • Contributors Z-YO and M-JQ visited and followed-up the patient. Z-YO, M-JQ, X-BW, and L-ST collected and analyzed the data. ZZ provided the diagnosis and suggested this patient. L-ST conducted the study. All authors contributed towards the study design and drafting of the article.

  • Funding The study was funded by the National Natural Science Foundation of China (81500991).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.