New diagnostic algorithm for detection of covert Bow Hunter's Syndrome

Abstract

Bow hunter's syndrome (BHS) should not be overlooked as a cause of cerebral infarction in the posterior circulation. However, covert BHS, which does not impair blood flow with simple rotation but only at certain angles, may make the diagnosis of BHS difficult. We propose a new algorithm to detect BHS or covert BHS. We recommend that BHS and covert BHS be detected by noninvasive duplex ultrasonography, which will allow for appropriate treatment.

Doppler sonography in diagnosis of Bow Hunter's syndrome

“…However, one of its advantages is the ability to assess the hemodynamic status of the vertebral artery quantitatively, including blood flow velocity during the cardiac cycle. This allows rapid and less invasive detection of hemodynamic changes in patients with Bow Hunter's syndrome 3 . In our patient, the site of blood flow obstruction during neck rotation remained undetermined, and the relationship between the features of nystagmus and the Doppler sonographic findings could not be clarified.…”

“…This allows rapid and less invasive detection of hemodynamic changes in patients with Bow Hunter's syndrome. 3 In our patient, the site of blood flow obstruction during neck rotation remained undetermined, and the relationship between the features of nystagmus and the Doppler sonographic findings could not be clarified. However, this case illustrates the utility of vertebral artery Doppler sonography for immediate detection of Bow Hunter's syndrome with minimal risk.…”

Bow Hunter's syndrome with clicking sounds: A rare etiology of transient loss of consciousness with tonic–clonic seizure

“…Furthermore, the operator could immediately detect a signal disappearance caused by the blood flow interruption or a probe shift. Hence, more reproducible hemodynamic changes and a feasible and easier detection can be obtained by using CAU in patients suspected to have BHS ( 25 ).…”

Clinical Reasoning: A 37-Year-Old Man Presenting With Intermittent Dizziness and Brief Choreiform Movements

“…Although DSA is the gold standard diagnostic technique, 7,8 noninvasive SPECT and TCD tests 8 are simple and easily accessible for the initial screening of BHS. There is no unified guideline for the treatment of BHS, and choices of treatment include conservative management, endovascular procedures, and surgery.…”