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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Bow hunter’s syndrome successfully treated with a posterior surgical decompression approach: A case report and review of literature
Niccolò Orlandi, Francesco Cavallieri, Ilaria Grisendi, Antonio Romano, Reza Ghadirpour, Manuela Napoli, Claudio Moratti, Matteo Zanichelli, Rosario Pascarella, Franco Valzania, Marialuisa Zedde
Niccolò Orlandi, Department of Biomedical, Metabolic and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena 41121, Italy
Francesco Cavallieri, Ilaria Grisendi, Franco Valzania, Marialuisa Zedde, Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia 42123, Italy
Francesco Cavallieri, Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena 41121, Italy
Antonio Romano, Reza Ghadirpour, Neurosurgery Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia 42123, Italy
Manuela Napoli, Claudio Moratti, Matteo Zanichelli, Rosario Pascarella, Neuroradiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia 41123, Italy
Author contributions: Orlandi N, Cavallieri F, Valzania F and Zedde M reviewed the literature, designed the work and drafted and reviewed the manuscript critically; Grisendi I reviewed the literature and the manuscript critically; Romano A and Ghadirpour R were the patient’s neurosurgeons and reviewed the literature and the manuscript critically; Napoli M, Moratti C, Zanichelli M, and Pascarella R analysed and interpreted the imaging findings and reviewed the manuscript critically; all authors issued final approval for the version to be submitted.
Informed consent statement: The patient provided informed consent for video and image acquisition as well as for data storage in the medical record during hospitalization.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Marialuisa Zedde, MD, Doctor, Neurology Unit, Department of Neuromotor and Rehabilitation, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, Reggio Emilia 41123, Italy. marialuisa.zedde@ausl.re.it
Received: November 23, 2021
Peer-review started: November 23, 2021
First decision: January 12, 2022
Revised: January 23, 2022
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 16, 2022
BACKGROUND
Bow hunter’s syndrome (BHS) is a rare but surgically treatable cause of vertebrobasilar insufficiency due to dynamic rotational occlusion of the vertebral artery. Typically, patients present with posterior circulation transient ischaemic symptoms such as presyncope, syncope, vertigo, diplopia, and horizontal nystagmus, but irreversible deficits, including medullary and cerebellar infarctions, have also been described.
CASE SUMMARY
A 70-year-old patient presented an acute onset of vertigo and gait instability triggered by right head rotation. His medical history included previous episodes of unilateral left neck and occipital pain followed by light-headedness, sweating, and blurred vision when turning his head, and these episodes were associated with severe degenerative changes in the atlanto-dens and left atlanto-axial facet joints and right rotation of the C2 cervical vertebrae. Brain magnetic resonance imaging revealed the presence of acute bilateral cerebellar ischaemic lesions, while static vascular imaging did not reveal any vertebral artery abnormalities. Dynamic ultrasonography and angiography were performed and confirmed the presence of a dynamic occlusion of the vertebral artery V3-V4 segment when the head was rotated to the right secondary to left C1-C2 bone spur compression. Surgical decompression led to complete resolution of paroxysmal symptoms without neurological sequelae.
CONCLUSION
BHS should be considered in cases of repeated posterior circulation transient ischaemic attack or ischaemic stroke, particularly when associated with high cervical spine abnormalities.
Core Tip: Bow hunter’s syndrome (BHS) represents a paradigmatic example of vertebrobasilar insufficiency. It is an uncommon but potentially harmful condition whose clinical manifestations encompass posterior circulation transient ischaemic symptoms and irreversible deficits, including medullary and cerebellar infarctions. We present herein a case of BHS resulting from rotational occlusion of a nondominant left vertebral artery by C1-C2 bone spur compression that was successfully treated with posterior cervical decompression. This case highlights the role of dynamic vertebral digital subtraction angiography and neurosurgery in BHS diagnosis and treatment, respectively.
