Rotational vertebral artery occlusion syndrome, also known as bow hunter's syndrome, is a rare form of vertebrobasilar insufficiency secondary to dynamic compression of the usually dominant vertebral artery.
On this page:
Clinical features
Symptoms are usually transient and elicited upon rotation of the head to the affected side. These may include visual changes, syncope, vertigo, and dizziness 1.
Pathology
There is no degree of normal anatomical head rotation, flexion or extension which can precipitate ischemia. Therefore, any detected vertebrobasilar insufficiency should be presumed to be pathologic.
It has many predisposing etiologies but is most often due to large osteophytes, atlantoaxial hypermobility, or less often an aberrant course 1.
Radiographic features
Ultrasound
Dynamic Doppler ultrasonography may be used to establish the diagnosis.
Angiography (DSA)
The diagnosis is typically established using provocative digital subtraction cerebral angiography, in which the patient reproduces symptomatic movements, and the site of vertebral artery compression may be identified.
History and etymology
Bow hunting requires a stance that requires a right-angled rotation of the head. In addition, due to the strong tensile forces involved in archery, the hunter often stabilizes the nocked arrow by placing their thumb upon their occiput 2.
See also
Eagle syndrome: the anterior circulation equivalent
Unable to process the form. Check for errors and try again.