Juvenile Cerebral Infarction Caused by Bow Hunter’s Syndrome during Sport: Two Case Reports

Kageyama, Hiroto; Yoshimura, Shinichi; Iida, Takayuki; Shirakawa, Manabu; Uchida, Keiji; Tomogane, Yusuke; Miyaji, Yuki

doi:10.2176/nmc.cr.2015-0351

Cited by 15 publications

(8 citation statements)

References 18 publications

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“…20 Additional treatment options include vertebral artery sacrifice, which is not supported by literature nor recommended by this article, or vertebral artery stenting. Two cases in our table used vertebral artery stenting, but one of these 8 went on to require fusion. For the other patient, on long-term follow-up both stents were found to be sheared with complete occlusion of both vertebral arteries and muscular branch collateralization reconstituting V3.…”

Section: Discussionmentioning

confidence: 99%

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Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

2020

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Background: Bow hunter's syndrome, or occlusion of the vertebral artery with head rotation leading to ischemia and sometimes stroke, is rarely described in children. The authors review the literature and present a new case. Methods: Both OVID dating back to 1946 and PubMed records were reviewed using the terms (“Bow hunter syndrome” OR “bow hunter’s”) OR “rotational vertebral artery occlusion” combined with “child,” and limited to English language. SCOPUS and the bibliographies of cases found in the search were used to identify additional articles. Results: Twelve articles were found describing 25 patients; there were 26 patients when combined with our case. Ages ranged from 1 to 18 years. Most (88.5%, 23/26) were male. Medical treatments included aspirin, clopidogrel, abciximab, enoxaparin, warfarin, and cervical collar. Stenting was tried in 2 cases but did not work long-term. Surgical treatments included decompression, cervical fusion, or a combination. We present a new case of a 12-year-old girl with recurrent stroke who had bilateral vascular compression only visible on provocative angiographic imaging with head turn. She was referred for cervical fusion, and abnormal ligamentous laxity was noted intraoperatively. Conclusions: Bow hunter's syndrome is a rare but important cause of stroke since many of the patients experience recurrent strokes before the diagnosis is made. Reasons for the male predominance are unclear. Provocative angiography plays a key role in diagnosis, and both medical treatment and neurosurgical intervention may prevent recurrence.

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Section: Discussionmentioning

confidence: 99%

“…None of the patients had recurrence after the last reported treatment, but length of follow-up varied. Several patients 4,5,8 started with medical therapy but were taken for surgical intervention when medication failed to prevent recurrent stroke.…”

Section: Methodsmentioning

confidence: 99%

Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

2020

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“…Post hoc tests identified four homogenous subsets with regard to age: golf players were significantly older than participants of football, basketball, and combat sports; football players were also significantly younger than runners, tennis players, and people engaging in exercise/weight lifting and scuba diving (Figure 1(a)). The proportion of female patients also differed significantly 36 1 À Springboard diving 37 1 À Wakeboarding 38 1 À Waterskiing 39 1 À Surfing 40 1 À Kitesurfing 41 1 À Running/jogging 22 129 3 À Handball 74 1 À Hockey 78 1 À Paddle bal 40 1 À Bowling 84 1 À a Indicates which types of sports are included in between-group analyses (all groups with at least 10 cases). 'Yes': forming a main group, '(þ)': part of main group, 'À': not included in further analysis, '/': some of its constituents are included in between-group analyses.…”

Section: Resultsmentioning

confidence: 99%

Cervical artery dissection after sports – An analytical evaluation of 190 published cases

Schlemm

Nolte

Engelter

et al. 2017

European Stroke Journal

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Introduction: Cervical artery dissections may be preceded by mechanical trigger events, often related to sports. Methods: Using the MEDLINE database, we identified case reports and case series of sports-related cervical artery dissections. Information of the type of sport, age and gender of the patient, affected vessels, associated infarction, time delay, and neurological sequelae were extracted. Demographic and clinical characteristics were compared between sport groups using analysis of variance and Chi square tests. Differences were further assessed with adjusted post hoc tests and homogenous subsets. Results: A total of 115 reports describing 190 patients with cervical artery dissections related to 45 different sports were identified. The mean age of all patients was 35 years; 26% of all patients were women. Anterior and posterior circulation, as well as left and right side were affected with similar frequency. Patients belonging to different sport categories differed significantly with regard to age (p < 0.001), gender (p < 0.001), and affected circulation (anterior vs. posterior, p ¼ 0.02). The posterior circulation was most often affected in golf players (88%) and least often in individuals engaging in exercise (23%) and scuba divers (29%). Laterality (left vs. right) and mortality were similar between sport groups. Discussion: We performed a comprehensive review and analytical evaluation of case reports describing patients with cervical artery dissections after sport. Confirmation of our findings in prospective studies is needed. Conclusion: Cervical artery dissection has been described in relation to a wide variety of sports. The risk of injury to particular neurovascular structures may depend on the type sport involved. Discipline-specific incidence rates are not known.

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“…The cause was identified as stenosis caused by hyper-rotation apophyseal joint subluxation. 9 Missori et al 17 reported on a case of atlantoaxial rotatory subluxation resulting in transient blindness after a neck injury. A limited number of published studies cite ultrasonography as a valuable assessment tool.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Transient vision loss (TVL) and blindness have also been reported in some cases. 4,5,[7][8][9] Bow hunter syndrome studies are limited to case studies and case series. The largest overview of BHS to date was published by Jost and Daily 7 in 2015, in which 126 cases were described and categorized and in which a variety of causes, sites of stenosis, and treatment regimens are described.…”

Section: Introductionmentioning

confidence: 99%

Vascular Ultrasound Measurements After Atlas Orthogonal Chiropractic Care in a Patient With Bow Hunter Syndrome

Rectenwald

DeSimone

Sweat

2018

Journal of Chiropractic Medicine

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Objective: This case report describes chiropractic treatment for a patient diagnosed with bow hunter syndrome with transient vision loss (TVL). Clinical Features: A 39-year-old woman presented to a chiropractic clinic with hand and arm numbness that began after she was injured in a motor vehicle collision 18 months earlier. The primary symptom was TVL that began 3 days after the motor vehicle collision. At that time, she had been diagnosed with bow hunter syndrome using dynamic angiography findings. She had previously declined surgery recommended by her attending neurosurgeon at a local hospital. Intervention and Outcome: The patient was treated using atlas orthogonal chiropractic technique for 8 visits over a 6-week period. Examination before and the after the initial treatment included cervical radiographic analysis and vascular ultrasound measurement of the right and the left vertebral artery (VA). After the initial spinal manipulation, there was an improvement in blood flow volume of 8.2% in the left VA and 22.2% in the right VA. There was improvement of the symptom of TVL and a measured reduction of rotational misalignment of the first and second cervical vertebra on the radiographic views. After 6 weeks, the patient's perception of TVL was absent. Conclusion: A patient with TVL improved under chiropractic care using atlas orthogonal technique.

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Juvenile Cerebral Infarction Caused by Bow Hunter’s Syndrome during Sport: Two Case Reports

Cited by 15 publications

References 18 publications

Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

Cervical artery dissection after sports – An analytical evaluation of 190 published cases

Vascular Ultrasound Measurements After Atlas Orthogonal Chiropractic Care in a Patient With Bow Hunter Syndrome

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