Resident & Fellow Section

e-Pearls archive | Video e-Pearls archive |Submit an e-Pearl

Case

An 18-year-old male presented with occipital headache, vomiting, and ataxia. MRI/MRA brain revealed acute infarcts involving the bilateral cerebellar hemispheres and narrowing of the V2 segment of the left vertebral artery (Figure).

Figure 1

A: Axial MRI brain shows acute infarcts in the bilateral cerebellar hemispheres (arrows); B: DSA shows a tortuous left vertebral artery with irregularity at the V2 segment (arrow); C: On dynamic imaging during right neck rotation, cessation of flow through left vertebral artery (arrow), suggestive of Bow hunter syndrome.

Dynamic angiography during right neck rotation revealed complete cessation of flow through the left vertebral artery suggestive of Bow hunter syndrome due to bony defects in the upper cervical spine (Video).

“Bow hunter” refers to the rotational position of the head that a bowhunter assumes when properly aiming his bow. The patient declined cervical spine fusion and was managed empirically with dual antiplatelets and a life-long cervical collar. He was also counseled to avoid turning his neck to the right.

References

1. Regenhardt RW, Kozberg MG, Dmytriw AA, et al. Bow hunter's syndrome. Stroke. 2022;53(1):e26-e29; doi:10.1161/STROKEAHA.121.037253

Authors

Shashank Nagendra, Grant Medical College and JJ Hospitals, Mumbai; India; Avinash Gutte, Grant Medical College and JJ Hospitals, Mumbai; India

Disclosures

The authors report no disclosures.