Bow Hunter's Syndrome: A rare cause of vertebrobasilar insufficiency

Montaño, M.J. Gordillo; Alman, Kristin; Smith, Michelle J.; Boghosian, Garen; Enochs, W S

doi:10.1016/j.radcr.2021.01.041

Cited by 10 publications

(17 citation statements)

References 15 publications

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“…The gold standard for diagnosis remains digital subtraction angiography with head turns, which may also be essential for surgical planning and assessing response to treatment. 6 Treatments include conservative management with antithrombotic medications and behavioral modification to limit head rotation, surgical resection of the compressing structure, surgical C1-C2 fusion, surgical vertebral artery decompression, vertebral artery stenting, and rarely vessel sacrifice. 2 A multidisciplinary discussion involving the patient should be pursued, weighing the risks versus benefits of these options.…”

Section: Discussionmentioning

confidence: 99%

“…The syndrome is often exacerbated by a stenotic or hypoplastic contralateral vertebral artery that is unable to provide adequate collateral flow and by limited anterior circulation collateral flow across the posterior communicating arteries, both demonstrated in the case presented. 6 The exact prevalence and incidence of the bow hunter's syndrome is not well described given its relative rarity. 2 It most often presents during the fifth to seventh decades of life, and there may be a male predominance.…”

Section: Discussionmentioning

confidence: 99%

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Bow Hunter’s Syndrome

Regenhardt

Kozberg

Dmytriw

et al. 2022

Stroke

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bow Hunter’s Syndrome

Regenhardt

Kozberg

Dmytriw

et al. 2022

Stroke

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“…Traumatic fracture of the atlas was reported in one case [26]. Some of the other etiologies include longus colli muscle hypertrophy [27], disc herniation [28], occipital bone osseous anomaly [9,10], thick fibrous band [29], cervical vertebra osseous anomalies [30,31], tortuosity in the V1 segment [11], osteophyte formation [32][33][34][35][36][37], schwannoma [38], congenital bilateral C2 transverse foramina stenosis [39], thyroid cartilage compression [40], facet hypertrophy at C4-5 and associated spondylolisthesis [41], and congenital C2-C3 fusion [42].…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke Secondary to Dynamic Vertebral Artery Stenosis: Case Report and Review of the Literature

Bukhari¹,

Alghamdi²

2021

Cureus

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Ischemic stroke secondary to dynamic vertebral artery stenosis or occlusion, also known as "bow hunter's syndrome," is a rare stroke mechanism. We report a case of a 24-year-old man with multiple hereditary exostosis (MHE) diagnosed at childhood. His first presentation to a neurologist was due to neck pain and clinical syndrome suggestive of ischemia in the vertebrobasilar territory. A therapeutic occlusion was done successfully without complication. The patient was discharged two days later on aspirin alone. In follow up one year later he continued to be symptom free. Moreover, this stroke mechanism has been reported extensively in the literature in isolation or secondary to many underlying diseases. In total, there are 168 cases reported in the published English literature, in either case reports or small series. In this review, we found that by far, vertebral artery occlusion at the atlanto-axial (C1-2) level dominated most reported cases. The most frequent presentation that led to further investigation was syncope or pre-syncope provoked by head rotation to one side. To our knowledge, there is no previous report of any stroke syndrome related to MHE before our case. In this paper, we report the first case secondary to MHE and review the literature up to date since the first reported case in 1952.

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“…The surgical approach should be tailored to each individual patient based on the characteristic of the compression 1 , 2 , 3 , 4 , 8 . To those cases with uncovertebral joints originated osteophytes, after uncovertebral joints resection and partial discectomy, instrumented fusion was needed to reconstruct the stability of the cervical spine.…”

Section: Discussionmentioning

confidence: 99%

Anterior decompression of persistent vertebral artery occlusion caused by the cervical facet joint originated osteophyte

Ren

Chen

Zhang

et al. 2021

Orthopaedic Surgery

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Background: Persistent vertebral artery occlusion caused by compression of cervical facet joint originated osteophyte is exceptional rare. The authors sought to achieve adequate decompression of the vertebral artery (VA) with less stability decrease and movement restriction via the anterior approach, and to the authors' knowledge, no case of anterior decompression of this condition has been reported, and combination of intraoperative indocyanine green (ICG) angiography in the setting of VA decompression is also rare.Case presentation: A 77-year-old man presented continuous vertigo, unsteady gait and dysphagia with no relationship to the head movement. Preoperative computed tomography angiography (CTA) and digital substraction angiography (DSA) examination revealed the left vertebral artery was severely compressed at C 4-5 level with approximately 95% occlusion due to a left C 4-5 facet joint originated large osteophyte. Successful anterior decompression was performed without fusion and intraoperative ICG fluorescence angiography proved excellent blood flow. After surgery, vertebrobasilar insufficiency symptoms remarkably improved with no neurological deficits and no recurrence at 12 months' follow-up. Conclusions:The authors' therapeutic strategy of anterior decompression was successful in treating VA compression due to facet joint overgrowth with adequate exposure, no stability decrease and movement restriction, and lower rates of neck pain and blood loss.

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Bow Hunter's Syndrome: A rare cause of vertebrobasilar insufficiency

Cited by 10 publications

References 15 publications

Bow Hunter’s Syndrome

Bow Hunter’s Syndrome

Ischemic Stroke Secondary to Dynamic Vertebral Artery Stenosis: Case Report and Review of the Literature

Anterior decompression of persistent vertebral artery occlusion caused by the cervical facet joint originated osteophyte

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