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| IMAGE QUIZ ARCHIVE | ||||||
| Image Quiz | ||
| Vertigo, Faintness, Blurred Vision, and Weakness in a Woman with Rheumatoid Arthritis1 | ||
| A woman was diagnosed with rheumatoid arthritis in 1982, at the age of forty-five years. She was hospitalized repeatedly since 1998 because of difficulty walking due to arthritis of both hips and knees and, in 1998, she underwent a right total hip arthroplasty. Cervical pain developed in the spring of 1999. In the fall of 1999, she began experiencing neuralgia of the left greater occipital nerve when she extended her neck. At the same time, she had vertigo, a feeling of faintness, and slurred speech. These symptoms were transient and resolved shortly after their onset. | ||
| In December 1999, the patient had a spontaneous seizure and was unconscious for approximately five minutes. After that episode, she could not speak clearly for several hours. An electroencephalogram revealed normal findings. In June 2000, she lost consciousness again and had difficulty with her speech immediately thereafter. | ||
| Physical examination revealed no neurological abnormalities except for slow speech. The tendon reflexes were normal, and there were no pathological reflexes. Imaging studies were performed. | ||
| For larger view, click on image | ||
 Fig. 1. Lateral radiograph of the cervical spine, made in June 2000. |
 Figs. 2-A and 2-B. Magnetic resonance images, made in June 2000. |
 Figs. 3-A and 3-B. Fig. 3-A Angiogram (left), made in July 2000, of the left vertebral artery with the neck in neutral position. Fig. 3-B (right) Angiogram of the left vertebral artery with the neck held in extension. |
| What is the diagnosis? | ||
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