Vertebro-basilar stroke due to Bow-Hunter syndrome: an unusual presentation of rotatory atlanto-axial subluxation in a fourteen year old

Patankar, Amey P.

doi:10.1080/02688697.2019.1668538

Cited by 6 publications

(7 citation statements)

References 9 publications

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“…Our case and several other cases did not have evidence of dissection. 7,12 We suspect that in these cases, vertebral compression was discovered early, before significant vascular injury had occurred. Others have documented dissection occuring after initial presentation; one of the cases reported by Rollins et al 9 presented with a right vertebral dissection and developed a left vertebral dissection later on.…”

Section: Discussionmentioning

confidence: 97%

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: 97%

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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“…However, this technique requires a careful separation of the VA, which is difficult to perform [9]. [17,20]. We found this technique particularly suitable for the patients in this study.…”

Section: Discussionmentioning

confidence: 89%

“…On the contrary, Patkar et al and Salunke have used subfacetal screws for C2 screw placement [ 17 , 20 ]. We found this technique particularly suitable for the patients in this study.…”

Section: Discussionmentioning

confidence: 99%

Application of C2 subfacetal screws for the management of atlantoaxial dislocation in patients with Klippel-Feil syndrome characterized by a narrow C2 pedicle and high-riding vertebral artery

et al. 2022

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Objective This study aims to investigate the clinical application and feasibility of C2 subfacetal screws in patients with Klippel-Feil syndrome (KFS), narrow C2 pedicles, and high-riding vertebral arteries (HRVAs). Methods The clinical data of seven patients with KFS, atlantoaxial dislocation, narrow C2 pedicles, and HRVAs treated with C2 subfacetal screws were analyzed in this retrospective study. The internal height, isthmus height, and pedicle width of C2 vertebra were measured using preoperative computed tomography (CT). Subfacetal screws were inserted for 7 patients (12 sides). The position and length of the screws were observed using postoperative CT. Intraoperative dura mater and vertebral artery (VA) injuries were recorded. Bone fusion was observed using follow-up CT. Results The internal height was 10.5 ± 3.2 mm, the isthmus height was 3.7 ± 1.8 mm, the pedicle width was 3.0 ± 1.4 mm, and the screw length was 19.7 ± 1.5 mm. All patients had HRVAs and narrow pedicles. No injury to the dura mater and vertebral artery (VA) occurred in this group of patients. Bone fusion was achieved in all patients during follow-up. Conclusions In patients with KFS, HRVA, and a narrow C2 pedicle, there is sufficient space below the C2 articular surface for screw insertion. When the pedicle is narrow and the C2 pedicle screw is not suitable for placement due to possible injury to the VA, subfacetal screws are a feasible alternative.

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“…According to the literature, bow hunter syndrome primarily affects individuals between the ages of 50 and 70 [ 9 ]. However, it can also occur in adolescents and young adults, with the left vertebral artery being commonly affected [ 7 ].…”

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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Vertebro-basilar stroke due to Bow-Hunter syndrome: an unusual presentation of rotatory atlanto-axial subluxation in a fourteen year old

Cited by 6 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

Application of C2 subfacetal screws for the management of atlantoaxial dislocation in patients with Klippel-Feil syndrome characterized by a narrow C2 pedicle and high-riding vertebral artery

Bilateral Bow Hunter Syndrome Associated with Loss of Cervical Physiological Curvature

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