Bilateral Cerebellar Infarcts from Vertebral Artery Insufficiency Caused by Cervical Osteophytes

Abstract

Abstract Background: In previous reports, the patients are described to have transient symptoms from physiologic rotation or extension of the cervical spine, resulting from a cervical osteophyte compressing the vertebral artery and causing vertebral artery insufficiency, known as Bow Hunter syndrome. Methods: An 85-year-old female presented with new onset occipital headaches, nausea, vomiting and vertigo that were not precipitated by change in head position. Patient had bilateral cerebellar infracts. Patient underwent decompression and instrumented stabilization of the cervical spine from the posterior approach. Results: At one-year follow-up, patient remained stroke free with patent vertebral artery. Conclusion: To our knowledge, this is the first report of bilateral infraction from a vertebral artery insufficiency caused by cervical osteophytes without history of transient symptoms from movement of the head or neck, a variant of the Bow Hunter syndrome. Anterior versus posterior approach for vertebral artery insufficiency from osteophytic compression should be primarily based on location of the pathology and not the cervical level of involvement.