Atlanto-occipital ligament calcification: a novel imaging finding in pediatric rotational vertebral artery occlusion

Nl, Cohen; Harrar, Dana; Diab, Yaser; Pearl, Monica S.; Murnick, Jonathan

doi:10.1007/s00247-019-04515-0

Cited by 7 publications

(6 citation statements)

References 9 publications

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“…5 Ligamentous laxity appeared to be the cause of bow hunter's syndrome in our patient, because no bony abnormalities were seen on imaging. Although one might suspect connective tissue disorders could contribute to bow hunter's syndrome, only 1 13 of the 26 patients in Table 1 received a genetic workup for connective tissue disorders, and this child was negative; this issue needs further study. Trauma may play a role in some cases; almost a quarter of the cases in Table 1 reported some sort of trauma or strenous sports participation before presentation.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, if vertebral artery dissection accompanies dynamic occlusion, prevention of secondary stroke begins with antithombotic treatment and immobilization until evidence of dissection resolution. 4,9,11,13 However, the cases in Table 1 with recurrent stroke started with aspirin therapy, then therapy was escalated when recurrent stroke occurred on aspirin, suggesting that in many cases, medical therapy alone is not enough. Specific pathology should then be used as a guide for further intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Almost a quarter (23%, 6/26) had reports of head/neck trauma or intensive sports participation before symptom onset; 1 patient also received chiropractic neck manipulation after a fall. 11 One patient received a genetic workup for connective tissue disorder, 13 although several did have normal echocardiography, suggesting those patients did not have cardiac signs of connective tissue disorder. Our reported patient has not yet received genetic evaluation for connective tissue disorder because her follow-up stroke clinic visit was canceled because of the COVID-19 pandemic.…”

Section: Methodsmentioning

confidence: 99%

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Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

2020

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Background: Bow hunter's syndrome, or occlusion of the vertebral artery with head rotation leading to ischemia and sometimes stroke, is rarely described in children. The authors review the literature and present a new case. Methods: Both OVID dating back to 1946 and PubMed records were reviewed using the terms (“Bow hunter syndrome” OR “bow hunter’s”) OR “rotational vertebral artery occlusion” combined with “child,” and limited to English language. SCOPUS and the bibliographies of cases found in the search were used to identify additional articles. Results: Twelve articles were found describing 25 patients; there were 26 patients when combined with our case. Ages ranged from 1 to 18 years. Most (88.5%, 23/26) were male. Medical treatments included aspirin, clopidogrel, abciximab, enoxaparin, warfarin, and cervical collar. Stenting was tried in 2 cases but did not work long-term. Surgical treatments included decompression, cervical fusion, or a combination. We present a new case of a 12-year-old girl with recurrent stroke who had bilateral vascular compression only visible on provocative angiographic imaging with head turn. She was referred for cervical fusion, and abnormal ligamentous laxity was noted intraoperatively. Conclusions: Bow hunter's syndrome is a rare but important cause of stroke since many of the patients experience recurrent strokes before the diagnosis is made. Reasons for the male predominance are unclear. Provocative angiography plays a key role in diagnosis, and both medical treatment and neurosurgical intervention may prevent recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

2020

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“…There were 22 patients with BHS due to embolic mechanisms, including the present case, as shown in Table 1. 3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18] The overall mean age of the patients was 31 ± 22 years (Table 2). BHS due to an embolic mechanism was observed in 20 men and 2 women.…”

Section: Results Of the Literature Reviewmentioning

confidence: 99%

“… 21 These examinations are also useful in detecting the underlying etiology of VA compression, such as osteophytes, bone spurs, atlantoaxial instability, cervical disc herniation, and congenital bony anomalies. 2 , 3 , 5 , 6 , 9 , 10 , 15 , 17 In contrast to BHS due to hemodynamic insufficiency, vessel wall injury, such as stenosis, dissection, and pseudoaneurysm at the compression site, is the key finding for the diagnosis of BHS due to an embolic mechanism, which can usually be detected with angiography. In the present case, dynamic digital subtraction angiography revealed stenotic VA changes in the neutral head position as well as VA occlusion in the rotated neck position.…”

Section: Discussionmentioning

confidence: 99%

Bow hunter’s syndrome due to an embolic mechanism: illustrative case

Shingai

Sakata

Endo

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUNDBow hunter’s syndrome (BHS) is an uncommon cause of vertebrobasilar ischemic stroke, which results from occlusion or injury to the vertebral artery (VA) during neck rotation. Although hemodynamic insufficiency is the predominant underlying mechanism of this entity, BHS due to embolic mechanisms is rare. The authors report a case of BHS characterized by repeated posterior circulation embolism and present some considerations of BHS with an embolic mechanism.OBSERVATIONSA 57-year-old man suffered from repeated embolic stroke in the posterior circulation. Digital subtraction angiography revealed caliber irregularity of the V3 segment of the left nondominant-side VA, which occluded when the neck rotated to the right side. The patient was diagnosed with BHS with an embolic mechanism due to endothelial damage caused by osteophytes at the C1 foramen transversarium. After C1–C2 fusion surgery, the patient never experienced the recurrence of stroke. According to a literature review, BHS due to embolic mechanisms tends to occur in young male adults, manifesting as recurrent stroke in the posterior circulation. Involvement of the nondominant-side VA can cause BHS with an underlying embolic mechanism.LESSONSBHS due to an embolic mechanism should be considered as a differential diagnosis if patients have repeated embolic strokes in the posterior circulation.

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Dynamic compression in vertebral artery dissection in children: apropos of a new protocol

et al. 2020

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Atlanto-occipital ligament calcification: a novel imaging finding in pediatric rotational vertebral artery occlusion

Cited by 7 publications

References 9 publications

Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

Bow hunter’s syndrome due to an embolic mechanism: illustrative case

Dynamic compression in vertebral artery dissection in children: apropos of a new protocol

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