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January 11, 2022; 98 (2) Resident & Fellow Section

Teaching Video NeuroImage: Dissociation of Abdominal Reflexes in Rheumatoid Atlantoaxial Subluxation

View ORCID ProfileIgor Vilela Brum, View ORCID ProfileGuilherme Diogo Silva
First published October 21, 2021, DOI: https://doi.org/10.1212/WNL.0000000000013007
Igor Vilela Brum
From the Department of Neurology, University of Sao Paulo, Brazil.
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Guilherme Diogo Silva
From the Department of Neurology, University of Sao Paulo, Brazil.
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Teaching Video NeuroImage: Dissociation of Abdominal Reflexes in Rheumatoid Atlantoaxial Subluxation
Igor Vilela Brum, Guilherme Diogo Silva
Neurology Jan 2022, 98 (2) e211-e212; DOI: 10.1212/WNL.0000000000013007

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A 59-year-old woman with rheumatoid arthritis presented with progressive gait difficulties and electric shock-like pain triggered by neck flexion (Lhermitte sign) for more than 6 months. On examination, she had hyperreflexia in the 4 limbs and brisk deep abdominal reflexes with absent superficial abdominal reflexes (reflex dissociation) (Video 1). MRI showed spinal cord compression resulting from anterior subluxation of the atlas and retrodental pannus (synovial tissue proliferation) (Figure). Superficial abdominal reflexes may be absent in 20% of normal individuals.1 However, the dissociation of abdominal reflexes suggests an upper motor neuron lesion above the T6 spinal segment.2

Video 1

Dissociation of abdominal reflexes. Absent superficial abdominal reflexes with brisk deep abdominal reflexes.Download Supplementary Video 1 via http://dx.doi.org/10.1212/013007_Video_1

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Figure Spinal Cord Compression by Atlantoaxial Subluxation and Retrodental Pannus

T2-weighted sagittal (A) spine MRI showing spinal cord compression and high signal intensity at the level of C1-C2 (dashed arrow) because of anterior subluxation of the atlas (solid arrow) and retrodental pannus (small arrow) in a patient with rheumatoid arthritis. T2-weighted axial (B) image confirms spinal cord compression by atlantoaxial subluxation (arrow, B).

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The authors report no targeted funding.

Disclosure

I.V. Brum reports no disclosures relevant to the manuscript; G.D. Silva reports no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

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  • Teaching slides links.lww.com/WNL/B633

  • © 2021 American Academy of Neurology

References

  1. 1.↵
    1. Madonick MJ
    . Statistical control studies in neurology: 8. The cutaneous abdominal reflex. Neurology. 1957;7(7):459-465.
    OpenUrlFREE Full Text
  2. 2.↵
    1. Teasdall RD,
    2. Van Den Ende H
    . A note on the deep abdominal reflex. J Neurol Neurosurg Psychiatry. 1982;45(4):382-383.
    OpenUrlAbstract/FREE Full Text

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