Dynamic magnetic resonance imaging to demonstrate C2 radiculopathy secondary to atlantoaxial osteoarthritis causing occipital neuralgia: A case report

Abstract

Background: The diagnosis of C2 radiculopathy associated with atlantoaxial osteoarthritis (AAOA) is challenging, because of its rarity and unique anatomy. We present a case of C2 radiculopathy secondary to AAOA causing occipital neuralgia that intensity changed depending on the position of the neck, which was definitively diagnosed by dynamic magnetic resonance imaging (MRI). Case description: An 83-year-old female presented with progressive, electric shock-like pain radiating from the right neck to the right occipital regions, following several-year chronic ipsilateral neck pain by AAOA. The neuralgia was aggravated by neck extension and reduced by neck flexion. AAOA and the right-sided C1-C2 neural foraminal stenosis without instability were diagnosed by X-rays and computed tomography. Dynamic MRI clearly showed that the extent of right C2 nerve root compression was changed parallel with the intensity of occipital neuralgia by neck position changes, leading to a definitive diagnosis of C2 radiculopathy. Decompression of the C2 nerve root achieved rapid and complete relief of the electric shock-like pain. Postoperative CT and MRI showed the release of the right C1-C2 neural foraminal stenosis and decompression of the right C2 nerve root. Conclusions: Dynamic MRI is useful to diagnose whether electric shock-like pain is caused by AAOA itself or C2 radiculopathy associated with AAOA.

Keywords

• C2 radiculopathy
• Occipital neuralgia
• Atlantoaxial osteoarthritis
• Dynamic MRI