An interesting case of dizziness: Bow Hunter's syndrome due to Kimmerle anomaly diagnosed with provocative DSA

Abstract

BACKGROUND: Rotational occlusion of the vertebral artery known as Bow hunter's syndrome(BHS) is a very rare cause for transient vertebrobasilar insufficiency symptoms. Complete or incomplete ossification of the posterior atlantooccipital membrane is called a Kimmerle anomaly which causes symptom in only 5.5% of patients with this anomaly. Early diagnosis with high index of clinical suspicion and provactive digital substraction angiography aids in prompt surgical repair, relieving the patient from the disabling symptoms and avoiding unnecessary ineffective symptomatic therapies.