Vertebral artery insufficiency and brain stem stroke syndrome as a result of cervical spine disease secondary to trauma, chiropractic manipulation, or rheumatoid arthritis have been reported in the literature (1-3). The vertebral arteries are seemingly wellprotected from external trauma as they course within the fciramina transversaria of the cervical vertebrae. However, when the alignment of the cervical spine is disturbed by disease or trauma, the arteries are in danger of being stretched, kinked, or compressed. A case of vertebral artery pseudoaneurysm formation following chiropractic manipulation has been reported (4). We report here another case of pseudoaneurysm of the vertebral artery, not resulting from trauma, but associated with cervical spine disease in a patient with severe: rheumatoid arthritis.
Case report. The patient, a 63-year-old white man, had had erosive rheumatoid arthritis (RA) since 1960. His rheumatoid disease had been refractory to conventional drug therapy, including gold, penicillamine, azathioprine, and methotrexate. He had taken corticosteroids for at least 10 years, in daily doses ranging from 10-30 mg of prednisone. Past surgical procedures included right total hip replacement, right wrist tlenosynovectomy with repair of extensor tendon rupture, bilateral total knee replacements (complicated Iby infection of the left knee prosthesis, which required extensive revisions), and resection arthro-From the Departments of Medicine and Surgery, the Rhode