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Bow Hunter Syndrome
Kevin R. Moore, MD; Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Bow hunter stroke, positional occlusion of vertebral artery, rotational occlusion of vertebral artery
            • Definitions

              • Vertebrobasilar insufficiency secondary to mechanical occlusion or stenosis of vertebral artery during head rotation due to fibrous band or bony prominence

            IMAGING

            • General Features

              • CT Findings

                • Ultrasonographic Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Mori M et al: Bow-hunter's syndrome due to left C7 schwannoma in a patient with bilateral absence of the posterior inferior cerebellar artery. J Orthop Sci. 24(5):939-44, 2019
                                  2. Patankar AP: Vertebro-basilar stroke due to bow-hunter syndrome: an unusual presentation of rotatory atlanto-axial subluxation in a fourteen year old. Br J Neurosurg. 1-3, 2019
                                  3. Agarwal V et al: Microsurgical treatment of bowhunter's syndrome: 3-dimensional operative video. Oper Neurosurg (Hagerstown). 15(6):E83, 2018
                                  4. Johnson SA et al: Rotational vertebral artery dissection secondary to anomalous entrance into transverse foramen. World Neurosurg. 108:998.e1-5, 2017
                                  5. Grandhi R et al: Bowhunter's syndrome. BMJ Case Rep. 2015, 2015
                                  6. Anaizi AN et al: Bow hunter's syndrome: the use of dynamic magnetic resonance angiography and intraoperative fluorescent angiography. J Neurosurg Spine. 20(1):71-4, 2014
                                  7. Lu DC et al: Rotational vertebral artery occlusion-series of 9 cases. Neurosurgery. 67(4):1066-72; discussion 1072, 2010
                                  8. Sugiu K et al: Endovascular treatment for bow hunter's syndrome: case report. Minim Invasive Neurosurg. 52(4):193-5, 2009
                                  9. Whitmore RG et al: Bow hunter's syndrome caused by accessory cervical ossification: posterolateral decompression and the use of intraoperative Doppler ultrasonography. Surg Neurol. 67(2):169-71, 2007
                                  10. Velat GJ et al: Intraoperative dynamic angiography to detect resolution of bow hunter's syndrome: technical case report. Surg Neurol. 66(4):420-3; discussion 423, 2006
                                  11. Horowitz M et al: Bow hunter's syndrome in the setting of contralateral vertebral artery stenosis: evaluation and treatment options. Spine (Phila Pa 1976). 27(23):E495-8, 2002
                                  12. Seki T et al: Anterior decompression of the atlantoaxial vertebral artery to treat bow hunter's stroke: technical case report. Neurosurgery. 49(6):1474-6, 2001
                                  13. Matsuyama T et al: Bow hunter's stroke caused by a nondominant vertebral artery occlusion: case report. Neurosurgery. 41(6):1393-5, 1997
                                  14. Matsuyama T et al: Comparison of C1-2 posterior fusion and decompression of the vertebral artery in the treatment of bow hunter's stroke. J Neurosurg. 86(4):619-23, 1997
                                  15. Fox MW et al: Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery. Case report. J Neurosurg. 83(4):737-40, 1995
                                  16. Sorensen BF: Bow hunter's stroke. Neurosurgery. 2(3):259-61, 1978
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Pathology

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Synonyms

                                              • Bow hunter stroke, positional occlusion of vertebral artery, rotational occlusion of vertebral artery
                                            • Definitions

                                              • Vertebrobasilar insufficiency secondary to mechanical occlusion or stenosis of vertebral artery during head rotation due to fibrous band or bony prominence

                                            IMAGING

                                            • General Features

                                              • CT Findings

                                                • Ultrasonographic Findings

                                                  • Angiographic Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • Gross Pathologic & Surgical Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Mori M et al: Bow-hunter's syndrome due to left C7 schwannoma in a patient with bilateral absence of the posterior inferior cerebellar artery. J Orthop Sci. 24(5):939-44, 2019
                                                                  2. Patankar AP: Vertebro-basilar stroke due to bow-hunter syndrome: an unusual presentation of rotatory atlanto-axial subluxation in a fourteen year old. Br J Neurosurg. 1-3, 2019
                                                                  3. Agarwal V et al: Microsurgical treatment of bowhunter's syndrome: 3-dimensional operative video. Oper Neurosurg (Hagerstown). 15(6):E83, 2018
                                                                  4. Johnson SA et al: Rotational vertebral artery dissection secondary to anomalous entrance into transverse foramen. World Neurosurg. 108:998.e1-5, 2017
                                                                  5. Grandhi R et al: Bowhunter's syndrome. BMJ Case Rep. 2015, 2015
                                                                  6. Anaizi AN et al: Bow hunter's syndrome: the use of dynamic magnetic resonance angiography and intraoperative fluorescent angiography. J Neurosurg Spine. 20(1):71-4, 2014
                                                                  7. Lu DC et al: Rotational vertebral artery occlusion-series of 9 cases. Neurosurgery. 67(4):1066-72; discussion 1072, 2010
                                                                  8. Sugiu K et al: Endovascular treatment for bow hunter's syndrome: case report. Minim Invasive Neurosurg. 52(4):193-5, 2009
                                                                  9. Whitmore RG et al: Bow hunter's syndrome caused by accessory cervical ossification: posterolateral decompression and the use of intraoperative Doppler ultrasonography. Surg Neurol. 67(2):169-71, 2007
                                                                  10. Velat GJ et al: Intraoperative dynamic angiography to detect resolution of bow hunter's syndrome: technical case report. Surg Neurol. 66(4):420-3; discussion 423, 2006
                                                                  11. Horowitz M et al: Bow hunter's syndrome in the setting of contralateral vertebral artery stenosis: evaluation and treatment options. Spine (Phila Pa 1976). 27(23):E495-8, 2002
                                                                  12. Seki T et al: Anterior decompression of the atlantoaxial vertebral artery to treat bow hunter's stroke: technical case report. Neurosurgery. 49(6):1474-6, 2001
                                                                  13. Matsuyama T et al: Bow hunter's stroke caused by a nondominant vertebral artery occlusion: case report. Neurosurgery. 41(6):1393-5, 1997
                                                                  14. Matsuyama T et al: Comparison of C1-2 posterior fusion and decompression of the vertebral artery in the treatment of bow hunter's stroke. J Neurosurg. 86(4):619-23, 1997
                                                                  15. Fox MW et al: Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery. Case report. J Neurosurg. 83(4):737-40, 1995
                                                                  16. Sorensen BF: Bow hunter's stroke. Neurosurgery. 2(3):259-61, 1978