Rotational vertebral artery occlusion syndrome
Updates to Article Attributes
Rotational vertebral artery occlusion syndrome, also known as bow hunter's syndrome, is a rare form of vertebrobasilar insufficiency secondary to dynamic compression of the usually-dominant dominant vertebral artery.
Clinical features
Symptoms are usually transient and elicited upon rotation of the head to the affected side. These may include visual changes, syncope, vertigo, and dizziness 1.
Pathology
There is no degree of normal anatomical head rotation, flexion or extension which can precipitate ischaemia. Therefore, any detected vertebrobasilar insufficiency should be presumed to be pathologic.
It has many predisposing aetiologies, but is most often due to large osteophytes, atlantoaxial hypermobility, or less often an aberrant course 1.
The significance of bow hunting in particular is that in addition to a stance which mandates right-angle rotation of the head, there is frequently also stabilisation of a nocked arrow with the hunter's thumb upon her occiput due to the high force used 2.
RadiographicsRadiographic features
Ultrasound
Dynamic Doppler ultrasonography may be used to establish the diagnosis.
Angiography (DSA)
The diagnosis is typically established using provocative digital subtraction cerebral angiography, in which the patient reproduces symptomatic movements, and the site of vertebral artery compression may be identified.
History and etymology
Dynamic Doppler ultrasonography may also be usedBow hunting requires a stance that requires a right-angled rotation of the head. In addition, due to establishthe strong tensile forces involved in archery, the diagnosis.
Significance
There is no degree of normal anatomical head rotation, flexion or extension which can precipitate ischemia and thus any detected insufficiency should be presumed pathologic.
The anterior circulation correlate to this phenomenon is Eagle syndromehunter often stabilises the nocked arrow by placing their thumb upon their occiput 2.
See also
Eagle syndrome: the anterior circulation equivalent
-<p><strong>Rotational vertebral artery occlusion syndrome</strong>, also known as <strong>bow hunter's syndrome</strong>, is a rare form of <a href="/articles/vertebrobasilar-insufficiency">vertebrobasilar insufficiency</a> secondary to dynamic compression of the usually-dominant <a href="/articles/vertebral-artery">vertebral artery</a>. </p><h4>Pathology</h4><p>It has many predisposing aetiologies, but is most often due to large <a href="/articles/osteophyte-2">osteophytes</a>, atlantoaxial hypermobility, or less often an aberrant course<sup> 1</sup>.</p><p>The significance of bow hunting in particular is that in addition to a stance which mandates right-angle rotation of the head, there is frequently also stabilisation of a nocked arrow with the hunter's thumb upon her occiput due to the high force used <sup>2</sup>.</p><h4>Radiographics features</h4><h5>Angiography</h5><p>The diagnosis is established using provocative digital subtraction cerebral angiography, in which the patient reproduces symptomatic movements, and the site of vertebral artery compression may be identified.</p><p>Dynamic Doppler ultrasonography may also be used to establish the diagnosis.</p><h4>Significance</h4><p>There is no degree of normal anatomical head rotation, flexion or extension which can precipitate ischemia and thus any detected insufficiency should be presumed pathologic.</p><p>The anterior circulation correlate to this phenomenon is <a title="Eagle syndrome" href="/articles/eagle-syndrome">Eagle syndrome</a>.</p><h4>See also</h4><ul>-<li><a href="/articles/vertebral-artery-thrombosis">vertebral artery occlusion</a></li>-<li><a href="/articles/atlanto-axial-subluxation">atlantoaxial subluxation</a></li>- +<p><strong>Rotational vertebral artery occlusion syndrome</strong>, also known as <strong>bow hunter's syndrome</strong>, is a rare form of <a href="/articles/vertebrobasilar-insufficiency">vertebrobasilar insufficiency</a> secondary to dynamic compression of the usually dominant <a href="/articles/vertebral-artery">vertebral artery</a>. </p><h4>Clinical features</h4><p>Symptoms are usually transient and elicited upon rotation of the head to the affected side. These may include visual changes, syncope, vertigo, and dizziness <sup>1</sup>.</p><h4>Pathology</h4><p>There is no degree of normal anatomical head rotation, flexion or extension which can precipitate ischaemia. Therefore, any detected vertebrobasilar insufficiency should be presumed to be pathologic.</p><p>It has many predisposing aetiologies but is most often due to large <a href="/articles/osteophyte-2">osteophytes</a>, atlantoaxial hypermobility, or less often an aberrant course<sup> 1</sup>.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Dynamic Doppler ultrasonography may be used to establish the diagnosis.</p><h5>Angiography (DSA)</h5><p>The diagnosis is typically established using provocative digital subtraction cerebral angiography, in which the patient reproduces symptomatic movements, and the site of vertebral artery compression may be identified.</p><h4>History and etymology</h4><p>Bow hunting requires a stance that requires a right-angled rotation of the head. In addition, due to the strong tensile forces involved in archery, the hunter often stabilises the nocked arrow by placing their thumb upon their occiput <sup>2</sup>.</p><h4>See also</h4><ul>
- +<li><p><a href="/articles/vertebral-artery-thrombosis">vertebral artery occlusion</a></p></li>
- +<li><p><a href="/articles/atlanto-axial-subluxation">atlantoaxial subluxation</a></p></li>
- +<li><p><a href="/articles/eagle-syndrome" title="Eagle syndrome">Eagle syndrome</a>: the anterior circulation equivalent</p></li>
References changed:
- 1. Liu X & Zhao J. Pay Attention to the Diagnosis and Management of Bow Hunter's Syndrome. World Neurosurg. 2014;82(5):593-4. <a href="https://doi.org/10.1016/j.wneu.2014.04.073">doi:10.1016/j.wneu.2014.04.073</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24802842">Pubmed</a>
- 2. Sorensen B. Bow Hunter's Stroke. Neurosurgery. 1978;2(3):259-61. <a href="https://doi.org/10.1227/00006123-197805000-00013">doi:10.1227/00006123-197805000-00013</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/732978">Pubmed</a>
- 1. Liu X, Zhao J. Diagnosis and management of Bow Hunter's Syndrome-A Perspective Statement. World Neurosurg. 2014;<a href="http://dx.doi.org/10.1016/j.wneu.2014.04.073">doi:10.1016/j.wneu.2014.04.073</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/24802842">Pubmed citation</a><div class="ref_v2"></div>
- 2. Sorensen BF. Bow hunter's stroke. (1978) Neurosurgery. 2 (3): 259-61. <a href="https://www.ncbi.nlm.nih.gov/pubmed/732978">Pubmed</a> <span class="ref_v4"></span>
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