Abstract
BACKGROUNDBow hunter’s syndrome or stroke (BHS) is characterized by rotational vertebrobasilar insufficiency elicited by rotation of the neck. It is caused by dynamic and reversible occlusion of the vertebral artery (VA). Reversible symptoms of rotational vertebrobasilar insufficiency are described as bow hunter’s syndrome, although brain infarction is rarely reported as bow hunter’s stroke.OBSERVATIONSA 70-year-old man experienced repeated cerebellar infarctions three times in the posterior inferior cerebellar artery (PICA) distribution of the nondominant right VA connecting the basilar artery. The onset of symptoms indicating cerebellar infarcts and the patient’s head position changes were unrelated. Dynamic digital angiography (DA) revealed that the nondominant right VA was occluded by an osteophyte from the C4 vertebral body, and the right PICA branches were shown to be passing through the distal right VA from the left VA. These findings were observed when the patient’s head was tilted to the right. An arterio-arterial embolic mechanism was suggested as the cause of repeated cerebellar infarctions.LESSONSTransient nondominant VA occlusion has been rarely reported as a cause of BHS when the head is tilted. To confirm the diagnosis of BHS, additional head tilt is recommended when performing dynamic DA in patients with a cervical osteophyte.
Highlights
Bow hunter’s syndrome or stroke (BHS) is characterized by rotational vertebrobasilar insufficiency elicited by rotation of the neck
No additional cerebellar infarction developed for 1 year 6 months after the surgery. In this patient, repeated cerebellar infarction was restricted to the posterior inferior cerebellar artery (PICA) distribution with reversible occlusion of the ipsilateral
Nondominant right vertebral artery (VA) and was demonstrated three times on MRI and magnetic resonance angiography (MRA) in the past 2 years after a C3–C6 left laminoplasty that had been performed 5 years earlier. 3D-CTA showed an osteophyte of C4 compressing the right VA laterally without stenosis
Summary
Bow hunter’s syndrome or stroke (BHS) is characterized by rotational vertebrobasilar insufficiency elicited by rotation of the neck It is caused by dynamic and reversible occlusion of the vertebral artery (VA). Dynamic digital angiography (DA) revealed that the nondominant right VA was occluded by an osteophyte from the C4 vertebral body, and the right PICA branches were shown to be passing through the distal right VA from the left VA These findings were observed when the patient’s head was tilted to the right. KEYWORDS repeated cerebellar infarction; bow hunter’s syndrome; stroke; cervical osteophyte; transient vertebral artery occlusion; head tilt. No symptoms or additional infarction occurred after surgery with posterior fixation of the cervical spine (C3–C6)
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