Recurrent stereotyped TIAs: atypical Bow Hunter’s syndrome due to compression of non-dominant vertebral artery terminating in PICA

Stefano, Vincenzo Di; Colasurdo, Marco; Onofrj, Marco; Caulo, Massimo; Angelis, Maria Vittoria De

doi:10.1007/s10072-020-04247-2

Cited by 8 publications

(4 citation statements)

References 6 publications

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“… 21 Conversely, recurrent TIAs can be evocative of SHM in patients with rare syndromes who fulfil criteria for HM. 61 Nevertheless, TIAs and strokes have a sudden onset, while HM typically shows gradual progressive spread with aura 1 ; the neuroimaging can be helpful to distinguish among these conditions, but the timing of the headache also provides relevant information, because the headache usually follows the motor weakness in HM and precedes the weakness in haemorrhagic strokes. 59 In addition, headache is common in haemorrhagic stroke, but it is rare in TIAs, and HM occurs more frequently in young people.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and therapeutic aspects of hemiplegic migraine

Stefano

Rispoli

Pellegrino

et al. 2020

J Neurol Neurosurg Psychiatry

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Hemiplegic migraine (HM) is a clinically and genetically heterogeneous condition with attacks of headache and motor weakness which may be associated with impaired consciousness, cerebellar ataxia and intellectual disability. Motor symptoms usually last <72 hours and are associated with visual or sensory manifestations, speech impairment or brainstem aura. HM can occur as a sporadic HM or familiar HM with an autosomal dominant mode of inheritance. Mutations in CACNA1A, ATP1A2 and SCN1A encoding proteins involved in ion transport are implicated. The pathophysiology of HM is close to the process of typical migraine with aura, but appearing with a lower threshold and more severity. We reviewed epidemiology, clinical presentation, diagnostic assessment, differential diagnosis and treatment of HM to offer the best evidence of this rare condition. The differential diagnosis of HM is broad, including other types of migraine and any condition that can cause transitory neurological signs and symptoms. Neuroimaging, cerebrospinal fluid analysis and electroencephalography are useful, but the diagnosis is clinical with a genetic confirmation. The management relies on the control of triggering factors and even hospitalisation in case of long-lasting auras. As HM is a rare condition, there are no randomised controlled trials, but the evidence for the treatment comes from small studies.

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Section: Introductionmentioning

confidence: 99%

Diagnostic and therapeutic aspects of hemiplegic migraine

Stefano

Rispoli

Pellegrino

et al. 2020

J Neurol Neurosurg Psychiatry

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“…Consequently, blood flow became difficult, posterior traffic was not opened, and there was no compensatory blood flow supplement in the anterior circulation, leading to symptoms of posterior circulation ischemia such as dizziness. Di Stefano et al suggested that the abnormal entry of the vertebral artery into the transverse foramen may be more prone to compression during long-path rotation, indicating a possible link between the vertebral artery pathway and the occurrence of bow hunter syndrome [ 13 ]. In the present case, it is likely that the loss of cervical physiological curvature altered the vertebral artery pathway, making it more susceptible to compression and the occurrence of bow hunter syndrome during rotation.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Bow Hunter Syndrome Associated with Loss of Cervical Physiological Curvature

Wang,

Bi,

Chen

2024

Am J Case Rep

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Patient: Female, 25-year-old Final Diagnosis: Bow-Hunter syndrome Symptoms: Dizziness • nausea • vertigo • vomiting Clinical Procedure: — Specialty: Neurology • Neurosurgery • Sports Medicine Objective: Rare disease Background: Bow hunter syndrome is a rare disease that is often overlooked. It presents with complex and variable clinical symptoms and causes, making diagnosis and treatment challenging. This case report focuses on a young patient with bilateral bow hunter syndrome, possibly caused by the loss of cervical physiological curvature. The aim is to enhance understanding and awareness of the disease. It is important to consider the possibility of bow hunter syndrome in young patients with long-term poor neck posture and symptoms such as dizziness, nausea, vomiting, and neck rotation-related symptoms. In such cases, thorough examination of posterior circulation hemodynamics and vascular morphology is recommended. Case Report: A 25-year-old woman was admitted to the hospital mainly because of “dizziness for 10 hours.” The dizziness was aggravated when the right side of the neck was turned and the body position changed. This was accompanied by visual rotation, nausea, and vomiting. Bow hunter syndrome was diagnosed based on the clinical symptoms and hemodynamic examination of the posterior circulation. The patient was given a cervical collar to limit excessive twisting of the neck and instructed to avoid large-angle deflection of the neck after discharge. During the 3-month follow-up, no characteristic symptoms (such as dizziness) reappeared. Conclusions: Bow hunter syndrome is a rare clinical posterior circulation compression syndrome with complex etiology. This case suggests that the simple disappearance of cervical curvature may be related to the occurrence of bow hunter syndrome. The dynamic monitoring of blood flow by color Doppler ultrasound and transcranial Doppler in different head positions provides clear clues to suspected bow hunter syndrome. With the help of computed tomography angiography, the diagnosis of bow hunter syndrome may be obtained by noninvasive examination.

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“…Isolated vertigo is also associated with migraine [ 56 ] and neuro-immunological diseases [ 47 ]. Lastly, there are rare genetic diseases [ 44 ], malformation syndromes [ 39 ] and vascular disorders [ 42 , 69 ] whose clinical manifestation, at the onset, can be represented by vertigo. To date, there are few data on functional pathological vertigo, which remains a diagnosis of exclusion [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

“…Repetitive vascular compressions in vertebral arteries (bowhunter’s syndrome) [ 69 ] or atherosclerosis in subclavian artery (subclavian steal syndrome) [ 42 ] are both conditions in which recurrent attacks of vertigo occur owing to an impaired vascular flow in posterior circulation [ 69 ]. However, even if vertigo can be the only reported complaint, there are usually associated neurological signs such as nystagmus, gaze palsy, pupillary defects or sensory-motor deficits [ 69 ]. Rarely, in adult age, vertigo has been reported in frontal lobe epilepsy as the sole ictal symptom at the seizure onset, or, more frequently, followed by other ictal signs/symptoms [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Neurological vertigo in the emergency room in pediatric and adult age: systematic literature review and proposal for a diagnostic algorithm

Pellegrino

Stefano

Rotondo³

et al. 2022

Ital J Pediatr

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Neurological vertigo is a common symptom in children and adults presenting to the emergency department (ED) and its evaluation may be challenging, requiring often the intervention of different medical specialties. When vertigo is associated with other specific symptoms or signs, a differential diagnosis may be easier. Conversely, if the patient exhibits isolated vertigo, the diagnostic approach becomes complex and only through a detailed history, a complete physical examination and specific tests the clinician can reach the correct diagnosis. Approach to vertigo in ED is considerably different in children and adults due to the differences in incidence and prevalence of the various causes. The aim of this systematic review is to describe the etiopathologies of neurological vertigo in childhood and adulthood, highlighting the characteristics and the investigations that may lead clinicians to a proper diagnosis. Finally, this review aims to develop an algorithm that could represent a valid diagnostic support for emergency physicians in approaching patients with isolated vertigo, both in pediatric and adult age.

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Recurrent stereotyped TIAs: atypical Bow Hunter’s syndrome due to compression of non-dominant vertebral artery terminating in PICA

Cited by 8 publications

References 6 publications

Diagnostic and therapeutic aspects of hemiplegic migraine

Diagnostic and therapeutic aspects of hemiplegic migraine

Bilateral Bow Hunter Syndrome Associated with Loss of Cervical Physiological Curvature

Neurological vertigo in the emergency room in pediatric and adult age: systematic literature review and proposal for a diagnostic algorithm

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