{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:13:03Z","timestamp":1769724783604,"version":"3.49.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"10","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,9,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Calcium pyrophosphate dihydrate (CPPD) deposition disease at the craniocervical junction (CCJ) typically presents with a retro-odontoid pseudotumor. Here, the authors report a case of CPPD-induced basilar impression, causing vertebral artery (VA) dissection and hemorrhage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 65-year-old male presented with worsening chronic cervicalgia, occipital headaches, and unstable tandem gait. CT revealed basilar impression with severe atlantoaxial erosion and instability, absent on imaging 8 months prior. MRI showed high-grade CCJ stenosis without myelopathy, due to CPPD. Before treatment could be initiated, the patient was suddenly found unresponsive. CT showed posterior fossa hemorrhage due to VA dissection, with secondary obstructive hydrocephalus. An external ventricular drain was placed, followed by coil VA embolization. After halo vest placement, CCJ alignment was restored and the patient underwent occipitocervical fusion. Following prolonged rehabilitation, he regained independent living without significant neurological sequelae.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This is the first reported case of VA dissection with posterior fossa hemorrhage secondary to basilar impression due to CPPD. Inflammatory arthritides of the CCJ may cause rapidly progressive atlantoaxial erosion, predisposing one to unstable basilar impression and VA dissection. Awareness of this risk is crucial in the surgical management of inflammatory basilar impression, where preoperative vascular imaging may be warranted in selected cases.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25332\">https:\/\/thejns.org\/doi\/10.3171\/CASE25332<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25332","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T06:39:43Z","timestamp":1757313583000},"source":"Crossref","is-referenced-by-count":0,"title":["CPPD-related basilar impression with vertebral artery dissection and subsequent subarachnoid hemorrhage: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8615-3694","authenticated-orcid":true,"given":"Sara","family":"Smeets","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital East-Limburg, Genk, Limburg, Belgium"},{"name":"Department of Neurosurgery, University Hospitals Leuven, Flemish Brabant, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Daenekindt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital East-Limburg, Genk, Limburg, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Weyns","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital East-Limburg, Genk, Limburg, Belgium"},{"name":"Neurosciences, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Limburg, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christophe","family":"Oosterbos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital East-Limburg, Genk, Limburg, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"8","key":"bib1","series-title":"J Neurosurg Case Lessons","first-page":"CASE21662","article-title":"Calcium pyrophosphate dihydrate crystal deposition disease and retro-odontoid pseudotumor rupture managed via posterior occipital cervical instrumented fusion: illustrative case","volume":"3","author":"Malhotra","year":"2022","unstructured":"Malhotra AKMalhotra ARLandry APCalcium pyrophosphate dihydrate crystal deposition disease and retro-odontoid pseudotumor rupture managed via posterior occipital cervical instrumented fusion: illustrative case. J Neurosurg Case Lessons. 2022;3(8):CASE21662."},{"key":"bib2","series-title":"World Neurosurg","first-page":"323","article-title":"Basilar impression: a systematic review and meta-analysis of clinical features, operative strategies, and outcomes","volume":"189","author":"Barrie","year":"2024","unstructured":"Barrie UTao JAzam FBasilar impression: a systematic review and meta-analysis of clinical features, operative strategies, and outcomes. World Neurosurg. 2024;189:323-338.e25."},{"issue":"1","key":"bib3","series-title":"BMC Musculoskelet Disord","first-page":"713","article-title":"Cervical myelopathy due to subaxial calcium pyrophosphate dihydrate (CPPD) deposition with simultaneous asymptomatic crowned dens syndrome: two case reports","volume":"21","author":"Chang","year":"2020","unstructured":"Chang DGPark JBJung HYSeo KJ.Cervical myelopathy due to subaxial calcium pyrophosphate dihydrate (CPPD) deposition with simultaneous asymptomatic crowned dens syndrome: two case reports. BMC Musculoskelet Disord. 2020;21(1):713."},{"issue":"1","key":"bib4","series-title":"J Neurosurg Spine","first-page":"22","article-title":"Calcium pyrophosphate dihydrate crystal deposition in the craniovertebral junction","volume":"8","author":"Fenoy","year":"2008","unstructured":"Fenoy AJMenezes AHDonovan KAKralik SF.Calcium pyrophosphate dihydrate crystal deposition in the craniovertebral junction. J Neurosurg Spine. 2008;8(1):22-29."},{"issue":"4","key":"bib5","series-title":"Neurospine","first-page":"903","article-title":"Upper cervical compression myelopathy caused by the retro-odontoid pseudotumor with degenerative osteoarthritis and calcium pyrophosphate dihydrate disease: a case report and literature review","volume":"18","author":"Yurube","year":"2021","unstructured":"Yurube TIguchi TKinoshita KSadamitsu TKakutani K.Upper cervical compression myelopathy caused by the retro-odontoid pseudotumor with degenerative osteoarthritis and calcium pyrophosphate dihydrate disease: a case report and literature review. Neurospine. 2021;18(4):903-913."},{"issue":"2","key":"bib6","series-title":"Clin Rheumatol","first-page":"571","article-title":"Crowned dens syndrome, yet another rheumatic disease imposter","volume":"39","author":"Awisat","year":"2020","unstructured":"Awisat ARosner IRimar DCrowned dens syndrome, yet another rheumatic disease imposter. Clin Rheumatol. 2020;39(2):571-574."},{"issue":"5","key":"bib7","series-title":"Med J Aust","first-page":"199","article-title":"Crowned dens syndrome: a rare cause of neck pain and fever","volume":"206","author":"Jiang","year":"2017","unstructured":"Jiang MNavanathan S.Crowned dens syndrome: a rare cause of neck pain and fever. Med J Aust. 2017;206(5):199."},{"issue":"4","key":"bib8","series-title":"Rom J Intern Med","first-page":"212","article-title":"Orthostatic hypotension as an unusual presentation of spinal calcium pyrophosphate deposition disease: case report and review of literature","volume":"61","author":"De Azevedo","year":"2023","unstructured":"De Azevedo SMPichel RCFreitas ECampar AMarinho AMendon\u00e7a T.Orthostatic hypotension as an unusual presentation of spinal calcium pyrophosphate deposition disease: case report and review of literature. Rom J Intern Med. 2023;61(4):212-215."},{"issue":"1","key":"bib9","series-title":"J Neurosurg","first-page":"141","article-title":"Foramen magnum syndrome from pseudogout of the atlanto-occipital ligament: case report","volume":"71","author":"Ciricillo","year":"1989","unstructured":"Ciricillo SFWeinstein PR.Foramen magnum syndrome from pseudogout of the atlanto-occipital ligament: case report. J Neurosurg. 1989;71(1):141-143."},{"issue":"7","key":"bib10","series-title":"J Stroke Cerebrovasc Dis","first-page":"e245","article-title":"Vertebral artery dissection in rheumatoid arthritis with cervical spine disease","volume":"22","author":"Mahajan","year":"2013","unstructured":"Mahajan RHuisa BN.Vertebral artery dissection in rheumatoid arthritis with cervical spine disease. J Stroke Cerebrovasc Dis. 2013;22(7):e245-e246."},{"issue":"1","key":"bib11","series-title":"Radiology","first-page":"213","article-title":"Calcium pyrophosphate dihydrate crystal deposition in and around the atlantoaxial joint: association with type 2 odontoid fractures in nine patients","volume":"216","author":"Kakitsubata","year":"2000","unstructured":"Kakitsubata YBoutin RDTheodorou DJCalcium pyrophosphate dihydrate crystal deposition in and around the atlantoaxial joint: association with type 2 odontoid fractures in nine patients. Radiology. 2000;216(1):213-219."},{"issue":"2","key":"bib12","series-title":"Surg Neurol","first-page":"200","article-title":"Cervicomedullary compression secondary to massive calcium pyrophosphate crystal deposition in the atlantoaxial joint with intradural extension and vertebral artery encasement","volume":"67","author":"Sethi","year":"2007","unstructured":"Sethi KSGarg ASharma MCAhmad FUSharma BS.Cervicomedullary compression secondary to massive calcium pyrophosphate crystal deposition in the atlantoaxial joint with intradural extension and vertebral artery encasement. Surg Neurol. 2007;67(2):200-203."},{"issue":"6","key":"bib13","series-title":"Neurosurgery","first-page":"1174","article-title":"Magnetic resonance angiography for vertebral artery evaluation in rheumatoid arthritis patients","volume":"66","author":"Zenmyo","year":"2010","unstructured":"Zenmyo MIjiri KSasaki HMagnetic resonance angiography for vertebral artery evaluation in rheumatoid arthritis patients. Neurosurgery. 2010;66(6):1174-1180."},{"key":"bib14","series-title":"Neuropsychiatr Dis Treat","first-page":"2429","article-title":"Profiles of vertebral artery dissection with congenital craniovertebral junction malformation: four new cases and a literature review","volume":"16","author":"Xue","year":"2020","unstructured":"Xue SYang YLi PLiu PDu XMa X.Profiles of vertebral artery dissection with congenital craniovertebral junction malformation: four new cases and a literature review. Neuropsychiatr Dis Treat. 2020;16:2429-2447."},{"issue":"4","key":"bib15","series-title":"Neurosurgery","first-page":"835","article-title":"Vertebral artery dissection related to basilar impression: case report","volume":"36","author":"Dickinson","year":"1995","unstructured":"Dickinson LDTuite GFColon GPPapadopoulos SM.Vertebral artery dissection related to basilar impression: case report. Neurosurgery. 1995;36(4):835-838."},{"issue":"6","key":"bib16","series-title":"J Neurosurg Spine","first-page":"660","article-title":"Dissecting aneurysm of the radiculomedullary artery originating from extracranial vertebral artery dissection in a patient with rheumatoid cervical spine disease: an unusual cause of subarachnoid hemorrhage. Case report","volume":"7","author":"Toyota","year":"2007","unstructured":"Toyota SWakayama AFujimoto YSugiura SYoshimine T.Dissecting aneurysm of the radiculomedullary artery originating from extracranial vertebral artery dissection in a patient with rheumatoid cervical spine disease: an unusual cause of subarachnoid hemorrhage. Case report. J Neurosurg Spine. 2007;7(6):660-663."},{"issue":"8","key":"bib1","series-title":"J Neurosurg Case Lessons","first-page":"CASE21662","article-title":"Calcium pyrophosphate dihydrate crystal deposition disease and retro-odontoid pseudotumor rupture managed via posterior occipital cervical instrumented fusion: illustrative case","volume":"3","author":"Malhotra","year":"2022","unstructured":"Malhotra AKMalhotra ARLandry APCalcium pyrophosphate dihydrate crystal deposition disease and retro-odontoid pseudotumor rupture managed via posterior occipital cervical instrumented fusion: illustrative case. J Neurosurg Case Lessons. 2022;3(8):CASE21662."},{"key":"bib2","series-title":"World Neurosurg","first-page":"323","article-title":"Basilar impression: a systematic review and meta-analysis of clinical features, operative strategies, and outcomes","volume":"189","author":"Barrie","year":"2024","unstructured":"Barrie UTao JAzam FBasilar impression: a systematic review and meta-analysis of clinical features, operative strategies, and outcomes. World Neurosurg. 2024;189:323-338.e25."},{"issue":"1","key":"bib3","series-title":"BMC Musculoskelet Disord","first-page":"713","article-title":"Cervical myelopathy due to subaxial calcium pyrophosphate dihydrate (CPPD) deposition with simultaneous asymptomatic crowned dens syndrome: two case reports","volume":"21","author":"Chang","year":"2020","unstructured":"Chang DGPark JBJung HYSeo KJ.Cervical myelopathy due to subaxial calcium pyrophosphate dihydrate (CPPD) deposition with simultaneous asymptomatic crowned dens syndrome: two case reports. BMC Musculoskelet Disord. 2020;21(1):713."},{"issue":"1","key":"bib4","series-title":"J Neurosurg Spine","first-page":"22","article-title":"Calcium pyrophosphate dihydrate crystal deposition in the craniovertebral junction","volume":"8","author":"Fenoy","year":"2008","unstructured":"Fenoy AJMenezes AHDonovan KAKralik SF.Calcium pyrophosphate dihydrate crystal deposition in the craniovertebral junction. J Neurosurg Spine. 2008;8(1):22-29."},{"issue":"4","key":"bib5","series-title":"Neurospine","first-page":"903","article-title":"Upper cervical compression myelopathy caused by the retro-odontoid pseudotumor with degenerative osteoarthritis and calcium pyrophosphate dihydrate disease: a case report and literature review","volume":"18","author":"Yurube","year":"2021","unstructured":"Yurube TIguchi TKinoshita KSadamitsu TKakutani K.Upper cervical compression myelopathy caused by the retro-odontoid pseudotumor with degenerative osteoarthritis and calcium pyrophosphate dihydrate disease: a case report and literature review. Neurospine. 2021;18(4):903-913."},{"issue":"2","key":"bib6","series-title":"Clin Rheumatol","first-page":"571","article-title":"Crowned dens syndrome, yet another rheumatic disease imposter","volume":"39","author":"Awisat","year":"2020","unstructured":"Awisat ARosner IRimar DCrowned dens syndrome, yet another rheumatic disease imposter. Clin Rheumatol. 2020;39(2):571-574."},{"issue":"5","key":"bib7","series-title":"Med J Aust","first-page":"199","article-title":"Crowned dens syndrome: a rare cause of neck pain and fever","volume":"206","author":"Jiang","year":"2017","unstructured":"Jiang MNavanathan S.Crowned dens syndrome: a rare cause of neck pain and fever. Med J Aust. 2017;206(5):199."},{"issue":"4","key":"bib8","series-title":"Rom J Intern Med","first-page":"212","article-title":"Orthostatic hypotension as an unusual presentation of spinal calcium pyrophosphate deposition disease: case report and review of literature","volume":"61","author":"De Azevedo","year":"2023","unstructured":"De Azevedo SMPichel RCFreitas ECampar AMarinho AMendon\u00e7a T.Orthostatic hypotension as an unusual presentation of spinal calcium pyrophosphate deposition disease: case report and review of literature. Rom J Intern Med. 2023;61(4):212-215."},{"issue":"1","key":"bib9","series-title":"J Neurosurg","first-page":"141","article-title":"Foramen magnum syndrome from pseudogout of the atlanto-occipital ligament: case report","volume":"71","author":"Ciricillo","year":"1989","unstructured":"Ciricillo SFWeinstein PR.Foramen magnum syndrome from pseudogout of the atlanto-occipital ligament: case report. J Neurosurg. 1989;71(1):141-143."},{"issue":"7","key":"bib10","series-title":"J Stroke Cerebrovasc Dis","first-page":"e245","article-title":"Vertebral artery dissection in rheumatoid arthritis with cervical spine disease","volume":"22","author":"Mahajan","year":"2013","unstructured":"Mahajan RHuisa BN.Vertebral artery dissection in rheumatoid arthritis with cervical spine disease. J Stroke Cerebrovasc Dis. 2013;22(7):e245-e246."},{"issue":"1","key":"bib11","series-title":"Radiology","first-page":"213","article-title":"Calcium pyrophosphate dihydrate crystal deposition in and around the atlantoaxial joint: association with type 2 odontoid fractures in nine patients","volume":"216","author":"Kakitsubata","year":"2000","unstructured":"Kakitsubata YBoutin RDTheodorou DJCalcium pyrophosphate dihydrate crystal deposition in and around the atlantoaxial joint: association with type 2 odontoid fractures in nine patients. Radiology. 2000;216(1):213-219."},{"issue":"2","key":"bib12","series-title":"Surg Neurol","first-page":"200","article-title":"Cervicomedullary compression secondary to massive calcium pyrophosphate crystal deposition in the atlantoaxial joint with intradural extension and vertebral artery encasement","volume":"67","author":"Sethi","year":"2007","unstructured":"Sethi KSGarg ASharma MCAhmad FUSharma BS.Cervicomedullary compression secondary to massive calcium pyrophosphate crystal deposition in the atlantoaxial joint with intradural extension and vertebral artery encasement. Surg Neurol. 2007;67(2):200-203."},{"issue":"6","key":"bib13","series-title":"Neurosurgery","first-page":"1174","article-title":"Magnetic resonance angiography for vertebral artery evaluation in rheumatoid arthritis patients","volume":"66","author":"Zenmyo","year":"2010","unstructured":"Zenmyo MIjiri KSasaki HMagnetic resonance angiography for vertebral artery evaluation in rheumatoid arthritis patients. Neurosurgery. 2010;66(6):1174-1180."},{"key":"bib14","series-title":"Neuropsychiatr Dis Treat","first-page":"2429","article-title":"Profiles of vertebral artery dissection with congenital craniovertebral junction malformation: four new cases and a literature review","volume":"16","author":"Xue","year":"2020","unstructured":"Xue SYang YLi PLiu PDu XMa X.Profiles of vertebral artery dissection with congenital craniovertebral junction malformation: four new cases and a literature review. Neuropsychiatr Dis Treat. 2020;16:2429-2447."},{"issue":"4","key":"bib15","series-title":"Neurosurgery","first-page":"835","article-title":"Vertebral artery dissection related to basilar impression: case report","volume":"36","author":"Dickinson","year":"1995","unstructured":"Dickinson LDTuite GFColon GPPapadopoulos SM.Vertebral artery dissection related to basilar impression: case report. Neurosurgery. 1995;36(4):835-838."},{"issue":"6","key":"bib16","series-title":"J Neurosurg Spine","first-page":"660","article-title":"Dissecting aneurysm of the radiculomedullary artery originating from extracranial vertebral artery dissection in a patient with rheumatoid cervical spine disease: an unusual cause of subarachnoid hemorrhage. Case report","volume":"7","author":"Toyota","year":"2007","unstructured":"Toyota SWakayama AFujimoto YSugiura SYoshimine T.Dissecting aneurysm of the radiculomedullary artery originating from extracranial vertebral artery dissection in a patient with rheumatoid cervical spine disease: an unusual cause of subarachnoid hemorrhage. Case report. 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