ArticleJournal of neurosurgery. Case lessons2021
Repeated cerebellar infarction in the affected nondominant vertebral artery distribution with reversible vertebral artery occlusion elicited by head tilt: illustrative case.
Article in Journal of neurosurgery. Case lessons, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed, 3 citations in OpenAlex.
- Challenging diagnosis of subaxial bow hunter's syndrome presenting with recurrent posterior circulation infarcts: illustrative case.Journal of neurosurgery. Case lessons · 2026Article
- Positional vertebral artery recanalization during neck flexion causing recurrent ischemic stroke.Radiology case reports · 2025Article
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Authors and funding
12 authors at 2 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundBow hunter's syndrome or stroke (BHS) is characterized by rotational vertebrobasilar insufficiency elicited by rotation of the neck. It is caused by dynamic and reversible occlusion of the vertebral artery (VA). Reversible symptoms of rotational vertebrobasilar insufficiency are described as bow hunter's syndrome, although brain infarction is rarely reported as bow hunter's stroke. OBSERVATIONS: A 70-year-old man experienced repeated cerebellar infarctions three times in the posterior inferior cerebellar artery (PICA) distribution of the nondominant right VA connecting the basilar artery. The onset of symptoms indicating cerebellar infarcts and the patient's head position changes were unrelated. Dynamic digital angiography (DA) revealed that the nondominant right VA was occluded by an osteophyte from the C4 vertebral body, and the right PICA branches were shown to be passing through the distal right VA from the left VA. These findings were observed when the patient's head was tilted to the right. An arterio-arterial embolic mechanism was suggested as the cause of repeated cerebellar infarctions. LESSONS: Transient nondominant VA occlusion has been rarely reported as a cause of BHS when the head is tilted. To confirm the diagnosis of BHS, additional head tilt is recommended when performing dynamic DA in patients with a cervical osteophyte.
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