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Neurological picture
Bow Hunter’s syndrome: an unusual case of bilateral dynamic occlusion of vertebral arteries
  1. Tahereh Toluian1,
  2. Daniel Volterra2,
  3. Andrea Gioppo2,
  4. Paolo Rigamonti2
  1. 1 Radiology, Università degli Studi di Milano, Milano, Lombardia, Italy
  2. 2 Neuroradiology, San Carlo Borromeo Hospital, Milano, Italy
  1. Correspondence to Dr Tahereh Toluian, Radiology, Università degli Studi di Milano, Milano, Lombardia, Italy; t.toluian{at}gmail.com

http://dx.doi.org/10.1136/jnnp-2021-326462

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    Case description

    A 54-year-old man came to our attention complaining of occasional tinnitus and blurred vision for 2 years, particularly when driving, the symptoms were linked to rightward head rotation.

    Neurological examination highlighted the occurrence of the reported symptoms at the neck right torsion beyond 45° after about 10 s.

    After a preliminary Echo-colour Doppler, the patient underwent a dynamic contrast-enhanced MR angiography (CE-MRA) of the supra-aortic trunks. In a neutral position, vertebral artery (VA) blood flow and calibre were regular with no evidence of dominance; scans performed a in rightward head rotation beyond 60° showed a bilateral dynamic stenosis of VAs, in particular at the C5–C6 level on the right, and at the C2 level on the left (figure 1).

    Figure 1

    Dynamic CE-MRA scans performed during right head rotation showing bilateral stenosis of the vertebral arteries at the C5–C6 level on the right (A, white arrow) and at the C2 level on the left (B, black arrow). CE-MRA, contrast-enhanced MR angiography.

    For diagnostic confirmation, a dynamic digital subtraction angiography (dDSA) was performed, adding selective injections of VAs at different degrees of right neck rotation. dDSA …

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    Footnotes

    • Contributors Each named author has substantially contributed to conducting the underlying research and drafting this manuscript. All Authors read and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.