Background/Aims:
Bow Hunter’s Syndrome is a rare syndrome of dynamic compression of the vertebral artery leading to recurrent posterior circulation stroke and/or transient ischaemic attack (TIA). The artery is compressed by the transverse process of a cervical vertebrae or other structures.
Methods:
We describe a 28-year-old male who had six transient posterior strokes and TIAs before the diagnosis of Bow Hunter’s Syndrome was made by the finding of dynamic left vertebral artery stenosis upon neck manoeuvrers during digital subtraction angiography (DSA).
Results:
The patient presented with acute onset cerebellar symptoms and associated computed tomography (CT) perfusion mismatch in the territory of the right superior cerebellar artery despite being on dual antiplatelets. A CT angiogram showed a bony spur of the left occipital condyle associated with stenosis of the V3 segment of left vertebral artery. The patient was managed conservatively because the symptoms resolved and a magnetic resonance imaging (MRI) did not reveal a new established stroke. Dynamic DSA showed an increase in the left vertebral artery stenosis with the neck extended and head turned to the right, producing significant flow delay. Patient was treated with open surgical decompression with removal of the bony spur due to the increased risk of continued injury to the left vertebral artery and future stroke. Six months after surgery there has been no further strokes or transient ischemic events.
Conclusion:
Bow Hunter’s Syndrome should be considered in patients with recurrent posterior circulation strokes and TIAs.