Bow Hunter's Syndrome Masquerading as Definite Ménière's Disease

Abstract

Bow Hunter's syndrome (BHS) results from vertebral-basilar insufficiency secondary to mechanical stenosis or occlusion of the unilateral vertebral artery at the atlanto-axis during head rotation. It is sometimes difficult to detect BHS, which is often ignored at other processes. A 44-year-old woman had up to 13 episodes of acute vertigo with left tinnitus, which was related to head rotation. Pure tone audiometry documented left side hearing impairment, so definite Ménière's disease was impressed; however, electronys-tagmography, a caloric test, posturagraphy, a cervical vestibular evoked myogenic potential, color-coded duplex sonography and magnetic resonance imaging/angiography disproved this. Ménière's disease was impressed and was attributed to BHS, which was related to a vertebral-basilar artery anomaly. The patient was treated conservatively and changed her work-style, and the symptoms did not recur over the following half year. Therefore, BHS can masquerade as Ménière's disease. We report this condition because of its rarity.