NEUROIMAGING / NEUROSONOLOGY
Bow Hunter´s syndrome
Created 09/12/2021, last revision 29/04/2023
Definition
- Bow Hunter´s syndrome (Rotational vertebral artery occlusion syndrome) is a symptomatic vertebrobasilar insufficiency caused by mechanical compression of the vertebral artery (VA) at the level of the atlanto-axial joint during head rotation within the normal physiologic range
Etiopathogenesis
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Clinical presentation
- clinical symptoms are provoked by unilateral head rotation (combined with retroflexion) and disappear after when the head is returned to the neutral position
- transient vertigo, visual disturbances
- drop attack or syncope
- TIA/stroke in the posterior circulation
- usually present with concomitant contralateral vertebral artery pathology (hypoplasia, stenosis/occlusion), which means that the dominant vertebral artery is compressed
Diagnostic evaluation
Dynamic Doppler ultrasonography
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Standard and dynamic cervical spine X-ray
- detects morphologic abnormalities in the spine
- dynamic images assess for spinal instability
- functional views should not be performed on trauma patients without the strict instructions of a clinician
Dynamic DSA
- DSA is performed during symptomatic move
- it identifies the side and level of the compression (can be anywhere from C6 entrance to C1/2 level)
- DSA cannot determine the exact cause of the compression
Dynamic CTA
- able to identify the exact location and cause of the compression
- higher radiation exposure compared to DSA
Dynamic MRA
- MR angiography can be a reliable and less invasive diagnostic tool and can be used instead of DSA
- it is suitable for confirming adequate postoperative decompression and for monitoring recurrence (Anaizi, 2013)
Management
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