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 cir...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.展开更多
BACKGROUND In bow hunter’s syndrome(BHS),also known as rotational vertebral artery(VA)syndrome,there is dynamic/rotational compression of the VA producing verte-brobasilar insufficiency.Most occurrences involve atlan...BACKGROUND In bow hunter’s syndrome(BHS),also known as rotational vertebral artery(VA)syndrome,there is dynamic/rotational compression of the VA producing verte-brobasilar insufficiency.Most occurrences involve atlantoaxial rather than mid-cervical VA compromise,the latter being rarely reported.Herein,we detail successful VA decompression at mid-cervical spine,given a departure from its usual course.CASE SUMMARY The patient,a 45-year-old man,presented to our hospital with occipital headache and vertigo.Computed tomography angiography showed anomalous C4 entry of right VA,with compression upon head rotation to that side.Thyroid cartilage and anterior tubercle of C5 transverse process were visibly at fault.We opted for sur-gery,using an anterior cervical approach to remove the anterior tubercle.Patient recovery was uneventful and brought resolution of all preoperative symptoms.CONCLUSION BHS is an important consideration where aberrant coursing of VA and neurologic symptoms coexist.展开更多
旋转性椎动脉闭塞综合征(rotational occlusion of the vertebral artery,ROVA)是一种因头颈旋转或后伸时椎动脉受到机械性压迫导致椎基底动脉供血不足进而出现的罕见症状综合征。其病因复杂且症状容易与心脑血管等疾病相混淆,所以临床...旋转性椎动脉闭塞综合征(rotational occlusion of the vertebral artery,ROVA)是一种因头颈旋转或后伸时椎动脉受到机械性压迫导致椎基底动脉供血不足进而出现的罕见症状综合征。其病因复杂且症状容易与心脑血管等疾病相混淆,所以临床上容易误诊,甚至漏诊。该病早期主要以一过性的体位性眩晕为主要临床表现,但如果处理不及时,晚期可能会导致后循环卒中等严重并发症。目前对该病尚认识不足,现就ROVA的病因、诊断和治疗进行综述,以提高临床医师对ROVA的认识。展开更多
文摘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.
文摘BACKGROUND In bow hunter’s syndrome(BHS),also known as rotational vertebral artery(VA)syndrome,there is dynamic/rotational compression of the VA producing verte-brobasilar insufficiency.Most occurrences involve atlantoaxial rather than mid-cervical VA compromise,the latter being rarely reported.Herein,we detail successful VA decompression at mid-cervical spine,given a departure from its usual course.CASE SUMMARY The patient,a 45-year-old man,presented to our hospital with occipital headache and vertigo.Computed tomography angiography showed anomalous C4 entry of right VA,with compression upon head rotation to that side.Thyroid cartilage and anterior tubercle of C5 transverse process were visibly at fault.We opted for sur-gery,using an anterior cervical approach to remove the anterior tubercle.Patient recovery was uneventful and brought resolution of all preoperative symptoms.CONCLUSION BHS is an important consideration where aberrant coursing of VA and neurologic symptoms coexist.
文摘旋转性椎动脉闭塞综合征(rotational occlusion of the vertebral artery,ROVA)是一种因头颈旋转或后伸时椎动脉受到机械性压迫导致椎基底动脉供血不足进而出现的罕见症状综合征。其病因复杂且症状容易与心脑血管等疾病相混淆,所以临床上容易误诊,甚至漏诊。该病早期主要以一过性的体位性眩晕为主要临床表现,但如果处理不及时,晚期可能会导致后循环卒中等严重并发症。目前对该病尚认识不足,现就ROVA的病因、诊断和治疗进行综述,以提高临床医师对ROVA的认识。
