Author:
Zhang Li,Gao Yu,Yu Xiao,Guo Ying,Piao Zhe,Nan Guangxian
Abstract
Abstract
Background
Bow Hunter’s syndrome (BHS), also known as rotational vertebral artery occlusion (RVAO), is a rare condition characterized by dynamic vertebrobasilar insufficiency due to position-dependent occlusion of the vertebral artery (VA). In the existing literature, most cases of BHS are attributed to osteophytic compression originating from the occipital condyle or within the transverse foramen, often accompanied by anatomical abnormalities of the VA. However, cases presenting solely with VA anomalies in the absence of any cervical vertebral structural abnormality are rare. This case report presents a unique instance of BHS in a 56-year-old male, attributed to the anomalous origin of the right VA and the absence of the left VA, without cervical structural abnormalities.
Case presentation
The patient exhibited symptoms like episodic dizziness and vertigo, which were exacerbated by rightward head rotation and alleviated upon returning to a neutral position. Diagnostic evaluation, including digital subtraction angiography, revealed that the right VA originated from the right common carotid artery and compression-induced stenosis of the right VA during head rotation. Conservative management, including avoidance of certain head movements and anti-arteriosclerosis medication, led to symptom resolution over a two-year follow-up period.
Conclusions
This report contributes to the understanding of BHS by highlighting a rare vascular anomaly presentation and incorporates a review of 14 similar case reports in the literature describing that an anatomical abnormality of the VA is mainly responsible for the pathology of BHS in the absence of cervical vertebral anomalies, thus emphasizing the need for careful diagnostic and management strategies.
Publisher
Springer Science and Business Media LLC
Reference26 articles.
1. Luzzi S, Gragnaniello C, Marasco S, Lucifero AG, Del Maestro M, Bellantoni G, et al. Subaxial vertebral artery rotational occlusion syndrome: an overview of clinical aspects, Diagnostic Work-Up, and Surgical Management. Asian Spine J. 2021;15:392–407.
2. Rastogi V, Rawls A, Moore O, Victorica B, Khan S, Saravanapavan P, et al. Rare etiology of Bow Hunter’s syndrome and systematic review of literature. J Vasc Interv Neurol. 2015;8:7–16.
3. Duan G, Xu J, Shi J, Cao Y. Advances in the Pathogenesis, diagnosis and treatment of Bow Hunter’s syndrome: a Comprehensive Review of the literature. Interv Neurol. 2016;5:29–38.
4. Jost GF, Dailey AT. Bow hunter’s syndrome revisited: 2 new cases and literature review of 124 cases. Neurosurg Focus. 2015;38:E7.
5. Schulz R, Donoso R, Weissman K. Rotational vertebral artery occlusion (bow hunter syndrome). Eur Spine J. 2021;30:1440–50.