Published online May 16, 2022. doi: 10.12998/wjcc.v10.i14.4494
Peer-review started: November 23, 2021
First decision: January 12, 2022
Revised: January 23, 2022
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 16, 2022
Processing time: 170 Days and 15 Hours
Bow hunter’s syndrome (BHS) is a rare but surgically treatable cause of vertebrobasilar insufficiency due to dynamic rotational occlusion of the vertebral artery. Typically, patients present with posterior circulation transient ischaemic symptoms such as presyncope, syncope, vertigo, diplopia, and horizontal nystagmus, but irreversible deficits, including medullary and cerebellar infarctions, have also been described.
A 70-year-old patient presented an acute onset of vertigo and gait instability triggered by right head rotation. His medical history included previous episodes of unilateral left neck and occipital pain followed by light-headedness, sweating, and blurred vision when turning his head, and these episodes were associated with severe degenerative changes in the atlanto-dens and left atlanto-axial facet joints and right rotation of the C2 cervical vertebrae. Brain magnetic resonance imaging revealed the presence of acute bilateral cerebellar ischaemic lesions, while static vascular imaging did not reveal any vertebral artery abnormalities. Dynamic ultrasonography and angiography were performed and confirmed the presence of a dynamic occlusion of the vertebral artery V3-V4 segment when the head was rotated to the right secondary to left C1-C2 bone spur compression. Surgical decompression led to complete resolution of paroxysmal symptoms without neurological sequelae.
BHS should be considered in cases of repeated posterior circulation transient ischaemic attack or ischaemic stroke, particularly when associated with high cervical spine abnormalities.
Core Tip: Bow hunter’s syndrome (BHS) represents a paradigmatic example of vertebrobasilar insufficiency. It is an uncommon but potentially harmful condition whose clinical manifestations encompass posterior circulation transient ischaemic symptoms and irreversible deficits, including medullary and cerebellar infarctions. We present herein a case of BHS resulting from rotational occlusion of a nondominant left vertebral artery by C1-C2 bone spur compression that was successfully treated with posterior cervical decompression. This case highlights the role of dynamic vertebral digital subtraction angiography and neurosurgery in BHS diagnosis and treatment, respectively.