Bow Hunter's Stroke Due to Instability at the Uncovertebral C3/4 Joint

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2011 Feb 1

PMID 21279658

Citations 10

Authors

Kazuhiro Yoshimura

Koichi Iwatsuki

Masahiro Ishihara

Yu-ichirou Onishi

Masao Umegaki

Toshiki Yoshimine

Affiliations

Soon will be listed here.

Abstract

Bow hunter's stroke is typically due to mechanical compression or stretching of the dominant vertebral artery (VA) during contralateral head rotation against the bony elements of the atlas and axis. We report a case of vertebrobasilar insufficiency due to bilateral vertebral artery occlusion at the left C3-4 and the right C1-2 junction on rightward head rotation. A 64-year-old man experienced ischemic symptoms during 90° head rotation to the right with complete resolution of symptoms after returning his head to the neutral position. Dynamic cervical angiography with rightward head rotation showed severe compression of the right VA at the transverse foramen of C3-4 and mechanical stenosis of the left VA at the C1-2 level. During head rotation, the flow of the right VA was decreased more than the left side. Cervical 3-D computed tomography (CT) on rightward head rotation demonstrated displacement of the uncovertebral C3-4 joint, with excessive rotation of the C3 vertebral body. Based on these findings, instability at C3-4 was suspected to be the main cause of the vertebrobasilar insufficiency. Anterior discectomy and fusion at the C3/4 level were performed. Postoperatively, the patient experienced complete resolution of symptoms, and dynamic cervical angiography showed disappearance of the compression of the right VA. To our knowledge, this is the first reported case of bow hunter's stroke diagnosed by dynamic cerebral angiography and cervical 3-D CT without angiography, and treated by anterior decompression and fusion without decompression of the VA.

Citing Articles

Bow Hunter's syndrome surgical approach and outcome: Two new cases and literature review.

Elizondo-Ramirez J, Herrera-Castro J, Del Rio-Martinez C, Torres-Figueroa O, Munoz-Cobos A, Ordonez-Solorio L Surg Neurol Int. 2024; 15:404.

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Safety and efficacy of dynamic catheter-directed cerebral digital subtraction angiography for diagnosis of bowhunter syndrome spectrum disorders: A systematic review of the literature.

Choi J, Qiao Y, Mehta T, Wilson J, Torigoe T, Tsappidi S Interv Neuroradiol. 2024; :15910199241236820.

PMID: 38477583 PMC: 11577335. DOI: 10.1177/15910199241236820.

Osteovascular Conflicts in the Neck Region and Cerebrovascular Events: Illustrative Cases and Literature Review.

Correia P, Meyer I, Michel P Global Spine J. 2023; 14(5):1629-1639.

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Ischemic Stroke Secondary to Dynamic Vertebral Artery Stenosis: Case Report and Review of the Literature.

Bukhari M, Alghamdi S Cureus. 2022; 13(12):e20167.

PMID: 35003995 PMC: 8724019. DOI: 10.7759/cureus.20167.

Subaxial Vertebral Artery Rotational Occlusion Syndrome: An Overview of Clinical Aspects, Diagnostic Work-Up, and Surgical Management.

Luzzi S, Gragnaniello C, Marasco S, Lucifero A, Del Maestro M, Bellantoni G Asian Spine J. 2020; 15(3):392-407.

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