scholarly journals Juvenile Bow Hunter's Stroke without Hemodynamic Changes

2010 ◽  
Vol 3 ◽  
pp. CCRep.S3555 ◽  
Author(s):  
Kozue Saito ◽  
Makito Hirano ◽  
Toshiaki Taoka ◽  
Hiroyuki Nakagawa ◽  
Takanori Kitauchi ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Vertebral Artery ◽  
Male Patient ◽  
Head Rotation ◽  
Underlying Mechanism ◽  
Vertebrobasilar Insufficiency ◽  
Hemodynamic Changes ◽  
Artery Embolism ◽  
Vertebrobasilar Stroke ◽  
Bow Hunter’S Stroke

Bow hunter's stroke (BHS) is a cerebrovascular disease caused by occlusion of the vertebral artery (VA) on head rotation. BHS is generally associated with hemodynamic changes, often leading to vertebrobasilar insufficiency symptoms, such as vertigo and faintness. Although artery-to-artery embolism has also been proposed as an underlying mechanism, it remains controversial. This report documents a case of BHS without hemodynamic changes. We describe a 26-year-old male patient who had VA occlusion on head rotation and repetitive infarction of thalami. He had an anomalous bypass of the VA and therefore no symptomatic hemodynamic changes. Thus, non-hemodynamic BHS should be considered in juvenile patients with vertebrobasilar stroke.

Comparison of C1–2 posterior fusion and decompression of the vertebral artery in the treatment of bow hunter's stroke

1997 ◽  
Vol 86 (4) ◽  
pp. 619-623 ◽  
Author(s):  
Takeshi Matsuyama ◽  
Tetsuya Morimoto ◽  
Toshisuke Sakaki
Keyword(s):  
Vertebral Artery ◽  
Head Rotation ◽  
Posterior Fusion ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Long Term Follow Up ◽  
Life Threatening ◽  
Neck Rotation ◽  
Bow Hunter’S Stroke

✓ Bow hunter's stroke results from vertebrobasilar insufficiency caused by mechanical occlusion or stenosis of the vertebral artery (VA) at the C1–2 level on head rotation. Surgical treatment of this condition may be chosen to avoid life-threatening accidents or because patients complain that conservative treatments such as verbal warnings or use of a neck brace to limit head and neck rotation are ineffective and thus restrict their lifestyle. Posterior fusion involving C1–2 has long been used to limit atlantoaxial rotational movements. However, it has the serious disadvantage that the range of head motion is severely reduced. Recently, decompression of the atlantoaxial portions of the affected VA has been used because it does not limit physiological neck movements. However, no long-term follow-up review of patients who have undergone this procedure has been conducted, and it is unclear whether this procedure always provides relief of symptoms. To answer this question, the results of C1–2 posterior fusion were compared with decompression of the VA for the treatment of bow hunter's stroke.

Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery

1995 ◽  
Vol 83 (4) ◽  
pp. 737-740 ◽  
Author(s):  
Mark W. Fox ◽  
David G. Piepgras ◽  
John D. Bartleson
Keyword(s):  
Vertebral Artery ◽  
Head Rotation ◽  
Artery Occlusion ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Mechanical Compression ◽  
Head Turning ◽  
Content Type ◽  
The Right ◽  
Bow Hunter’S Stroke

✓ A case of repeated vertebrobasilar ischemic attacks related to head rotation (bow hunter's stroke) is reported. With head rotation of 45° or more to the right, the patient would become lightheaded and feel as if she were going to lose consciousness. Angiography performed when head rotation was to the right revealed mechanical compression of the left vertebral artery at the foramen transversarium of the axis and an occluded right vertebral artery. Untethering of the vertebral artery as it passed through the foramen transversarium of the atlas in this case completely relieved the patient's symptoms. The authors conclude that contralateral vertebral artery occlusion predisposed this patient to symptomatic vertebrobasilar insufficiency secondary to ipsilateral vertebral artery mechanical stenosis induced by head turning.

Atlanto-Occipital Decompression of Vertebral Artery for a Variant of Bow Hunter's Syndrome: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Nickalus R Khan ◽  
Turki Elarjani ◽  
Stephanie H Chen ◽  
Laszlo Miskolczi ◽  
Sheryl Strasser ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Rare Condition ◽  
Head Rotation ◽  
Treatment Modalities ◽  
Spinal Instability ◽  
Vertebrobasilar Insufficiency ◽  
Common Etiology ◽  
Neurologically Intact ◽  
Hunter's Syndrome ◽  
Visual Abnormalities

Abstract Rotational vertebral artery (VA) occlusion syndrome, also known as bow hunter's syndrome, is an uncommon variant of vertebrobasilar insufficiency typically occurring with head rotation.1-3 The most common presenting symptom is dizziness (76.8%), followed by visual abnormalities and syncope (50.4% and 40.4%, respectively).2 Osteophytic compression due to spinal spondylosis has been shown to be the most common etiology (46.2%), with other factors, such as a fibrous band, muscular compression, or spinal instability, being documented.1,2 Treatment is dependent on the level and site of VA compression with anterior, anterolateral, or posterior approaches being described.1,4 We present the case of a 72-yr-old male with osteophytic compression of the V3 segment of the vertebral artery at the occipital-cervical junction. The patient underwent a C1 hemilaminectomy and removal of osteophytic compression from the occipital-cervical joint. The patient had complete resolution of compression of his vertebral artery on postoperative imaging and remained neurologically intact following the procedure. We review the literature on this topic, the technical nuances of the procedure performed, and review the different treatment modalities available for this rare condition.1-11  The patient consented to the procedure and to publication of their image.

Transient rotational compression of the vertebral artery caused by herniated cervical disc

2003 ◽  
Vol 98 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Andrew N. Nemecek ◽  
David W. Newell ◽  
Robert Goodkin
Keyword(s):  
Vertebral Artery ◽  
Head Rotation ◽  
Cervical Disc ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Vertebrobasilar Ischemia ◽  
Extrinsic Compression ◽  
The Many ◽  
Herniated Cervical Disc ◽  
Adequate Decompression

✓ Of the many causes of vertebrobasilar insufficiency (VBI), extrinsic compression of the vertebral artery (VA) is relatively uncommon. A syndrome of VBI caused by extrinsic compression of the VA secondary to head rotation has been termed positional vertebrobasilar ischemia. The authors present a case of transient VBI caused by herniation of a cervical disc. Transcranial Doppler ultrasonography was used preoperatively to confirm the diagnosis and intraoperatively to monitor cerebral perfusion and to confirm that adequate decompression of the VA had been achieved.

scholarly journals Rare cause of Bow Hunter’s syndrome due to an aberrant course of a vertebral artery

2019 ◽  
Vol 12 (7) ◽  
pp. e229584
Author(s):  
Kaishin Tanaka ◽  
Brendan Steinfort
Keyword(s):  
Vertebral Artery ◽  
Male Patient ◽  
Cervical Vertebrae ◽  
Distal Portion ◽  
Posterior Circulation ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Rare Entity ◽  
Hunter's Syndrome

Bow Hunter’s syndrome (BHS) is a rare cause of vertebrobasilar insufficiency and is reported to most commonly be caused by vertebral artery impingement on cervical vertebrae osteophytes. We report a case in a 56-year-old male patient who on investigation of recurrent posterior circulation ischaemic strokes was found to have BHS. The aetiology of the syndrome in this patient is due to a particularly unusual aberrancy in the path of the atlantoaxial portion of the culprit left vertebral artery. Aberrancy of the distal portion of the vertebral artery is in itself a rare entity, and there are few reports of it in relation to BHS. The patient in this case was successfully treated with endovascular sacrifice of the vertebral artery with no further dynamic occlusive symptoms.

scholarly journals Atypical presentation of rotational vertebral artery insufficiency: illustrative case

2021 ◽  
Vol 1 (9) ◽  
Author(s):  
Pranish A. Kantak ◽  
Sarv Priya ◽  
Girish Bathla ◽  
Mario Zanaty ◽  
Patrick W. Hitchon
Keyword(s):  
Vertebral Artery ◽  
Facet Joint ◽  
Head Rotation ◽  
Rotational Instability ◽  
Anatomical Location ◽  
Illustrative Case ◽  
Vertebrobasilar Insufficiency ◽  
Course Of Action ◽  
Heterogeneous Nature ◽  
The Right

BACKGROUNDRotational vertebral artery insufficiency (RVAI), also known as bow hunter’s syndrome, is an uncommon cause of vertebrobasilar insufficiency that leads to signs of posterior circulation ischemia during head rotation. RVAI can be subdivided on the basis of the anatomical location of vertebral artery compression into atlantoaxial RVAI (pathology at C1-C2) or subaxial RVAI (pathology below C2). Typically, RVAI is only seen with contralateral vertebral artery pathologies, such as atherosclerosis, hypoplasia, or morphological atypia.OBSERVATIONSThe authors present a unique case of atlantoaxial RVAI due to rotational instability, causing marked subluxation of the C1-C2 facet joints. This case is unique in both the mechanism of compression and the lack of contralateral vertebral artery pathology. The patient was successfully treated with posterior C1-C2 instrumentation and fusion.LESSONSWhen evaluating patients for RVAI, neurosurgeons should be aware of the variety of pathological causes, including rotational instability from facet joint subluxation. Due to the heterogeneous nature of the pathologies causing RVAI, care must be taken to decide if conservative management or surgical correction is the right course of action. Because of this heterogeneous nature, there is no set guideline for the treatment or management of RVAI.

Spontaneous atraumatic vertebral artery occlusion due to physiological cervical extension

2014 ◽  
Vol 20 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Mina G. Safain ◽  
Jordan Talan ◽  
Adel M. Malek ◽  
Steven W. Hwang
Keyword(s):  
Vertebral Artery ◽  
Head Movement ◽  
Head Rotation ◽  
Artery Occlusion ◽  
Vascular Compression ◽  
Vertebrobasilar Insufficiency ◽  
Cerebral Angiogram ◽  
Life Threatening ◽  
History Of ◽  
Hunter's Syndrome

Vertebral artery (VA) occlusion is a serious and potentially life-threatening occurrence. Bow hunter's syndrome, a mechanical occlusion of the VA due to physiological head rotation, has been well described in the medical literature. However, mechanical VA compression due to routine flexion or extension of the neck has not been previously reported. The authors present the unique case of a woman without any history of trauma who had multiple posterior fossa strokes and was found to have dynamic occlusion of her right VA visualized via cerebral angiogram upon extension of her neck. This occlusion was attributed to instability at the occipitocervical junction in a patient with a previously unknown congenital fusion of both the occiput to C-1 and C-2 to C-3. An occiput to C-3 fusion was performed to stabilize her cervical spine and minimize the dynamic vascular compression. A postoperative angiogram showed no evidence of restricted flow with flexion or extension of the neck. This case emphasizes the importance of considering symptoms of vertebrobasilar insufficiency as a result of physiological head movement. The authors also review the literature on VA compression resulting from physiological head movement as well as strategies for clinical diagnosis and treatment.

Positional vertebral artery compression and vertebrobasilar insufficiency due to a herniated cervical disc

2009 ◽  
Vol 11 (3) ◽  
pp. 326-329 ◽  
Author(s):  
Kenta Ujifuku ◽  
Kentaro Hayashi ◽  
Keishi Tsunoda ◽  
Naoki Kitagawa ◽  
Tomayoshi Hayashi ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Histopathological Examination ◽  
Head Rotation ◽  
Cervical Disc ◽  
Decompression Surgery ◽  
Vertebrobasilar Insufficiency ◽  
Intraoperative Angiography ◽  
The Right ◽  
Vertebral Artery Compression ◽  
Herniated Cervical Disc

The authors report a case of vertebrobasilar insufficiency caused by vertebral artery (VA) compression due to a herniated cervical disc, which was surgically treated with the aid of intraoperative angiography. This 78-year-old man visited the hospital because of syncope following head rotation. Admission CT scans revealed a calcified mass adjacent to the right lateral process of the C-4 spine. Cervical angiography demonstrated an obstruction of the right VA at this region on rotation of the head to the right. The operation revealed a cervical disc protruding toward the right VA. The disc was surgically removed, and then the decompression of the right VA was confirmed on intraoperative angiography studies. A histopathological examination showed fibrohyaline cartilage, indicating an ossified intervertebral disc. The postoperative course was uneventful, and he has not experienced any syncope since treatment. A cervical disc herniation could be a cause of vertebrobasilar insufficiency by exerting positional compression of the VA. Intraoperative angiography could be quite useful to confirm this condition during decompression surgery for a cervical VA.

Rotational vertebrobasilar insufficiency as a component of thoracic outlet syndrome resulting in transient blindness

1994 ◽  
Vol 81 (4) ◽  
pp. 617-619 ◽  
Author(s):  
James J. Sell ◽  
Jesse R. Rael ◽  
William W. Orrison
Keyword(s):  
Vertebral Artery ◽  
Thoracic Outlet Syndrome ◽  
Head Rotation ◽  
Cortical Blindness ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Aged Woman ◽  
Extrinsic Compression ◽  
Vertebral Artery Compression

✓ Cases of unilateral vertebral artery compression associated with thoracic outlet syndrome infrequently result in symptoms and, of those that do, most involve the brain stem. Reports of transient blindness resulting from this condition are even more rare. The authors describe the case of a middle-aged woman who presented with transient blindness when she turned her head excessively to the left. She also exhibited other less severe brainstem symptoms. Arteriography demonstrated occlusion of the left vertebral artery only when her head was rotated to the left. Surgical exploration revealed entrapment of the left vertebral artery by a tight anterior scalene muscle, release of which resulted in complete resolution of her symptoms. Both neurosurgeons and radiologists need to be aware that extrinsic compression of the vertebral artery precipitated by head rotation may sometimes result in transient cortical blindness.

scholarly journals Fusion for subaxial bow hunter’s syndrome results in remote osseous remodeling of the hyperostotic growth responsible for vertebral artery compression

2021 ◽  
Vol 12 ◽  
pp. 104
Author(s):  
Daniel Satoshi Ikeda ◽  
Charles A. Miller ◽  
Vijay M. Ravindra
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Complete Resolution ◽  
Dynamic Compression ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Head Rotation ◽  
Vertebrobasilar Insufficiency ◽  
The Right ◽  
Vertebral Artery Compression ◽  
Hunter's Syndrome

Background: The authors present a previously unreported case of a patient with diffuse idiopathic skeletal hyperostosis (DISH) who developed bow hunter’s syndrome (BHS) or positional vertebrobasilar insufficiency. In addition, the authors demonstrate angiographic evidence of remote osseous remodeling after segmental fusion without direct decompression of the offending bony growth. BHS is a rare, yet well established, cause of posterior circulation ischemia and ischemic stroke. Several etiologies such as segmental instability and spondylosis have been described as causes, however, DISH has not been associated with BHS before this publication. Case Description: A 77-year-old man who presented with BHS was found to have cervical spine changes consistent with DISH, and angiography confirmed right vertebral artery (VA) stenosis at C4–5 from a large pathological elongation of the right C5 lateral mass. Head rotation resulted in occlusion of the VA. The patient underwent an anterior cervical discectomy and fusion and reported complete resolution of his symptoms. A delayed angiogram and CT of the cervical spine demonstrated complete resolution of the baseline stenosis, no dynamic compression, and remote osseous remodeling of the growth, respectively. Conclusion: This case represents the first publication in the literature of DISH as a causative etiology of BHS and of angiographic data demonstrating resolution of a compressive osseous pathology without direct decompression in BHS.

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