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Review
. 2021 Mar 19;18(10):2162-2165.
doi: 10.7150/ijms.56442. eCollection 2021.

New diagnostic algorithm for detection of covert Bow Hunter's Syndrome

Luna Kimihira  1   2 , Takeshi Yoshimoto  1 , Masafumi Ihara  1
Affiliations
Review

New diagnostic algorithm for detection of covert Bow Hunter's Syndrome

Luna Kimihira et al. Int J Med Sci. .

Abstract

Bow hunter's syndrome (BHS) should not be overlooked as a cause of cerebral infarction in the posterior circulation. However, covert BHS, which does not impair blood flow with simple rotation but only at certain angles, may make the diagnosis of BHS difficult. We propose a new algorithm to detect BHS or covert BHS. We recommend that BHS and covert BHS be detected by noninvasive duplex ultrasonography, which will allow for appropriate treatment.

Keywords: algorithm; bow hunter's syndrome; covert bow hunter's syndrome; diagnosis.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Doppler ultrasound findings of covert BHS and normal physiology. In normal physiology, there is no decrease in the EDV at any cervical angle. In covert BHS, however, there is an apparent decrease in the EDV only at specific angles. However, covert BHS shows a typical waveform only by merely rotating the neck horizontally, which is its main difference from common BHS. Abbreviations: EDV, end-diastolic flow velocity; BHS, bow hunter's syndrome.
Figure 2
Figure 2
Ultrasonographic diagnostic chart for bow hunter's syndrome. Covert BHS is detected as follows. When the EDV of the VA is detectable, then the head should be rotated from side to side. BHS is suspected when the EDV of the VA disappears in a rotated position. When the EDV is maintained in simple rotation, the examiner should continue the evaluation at various head rotation angles. If the EDV is lost at a particular angle, the diagnosis of covert BHS can be confirmed. Abbreviations: BHS, bow-hunter's syndrome; EDV, end-diastolic flow velocity; PICA, posterior inferior cerebellar artery; VA, vertebral artery.
Figure 3
Figure 3
Nine positions to detect covert bow hunter's syndrome. The nine preferred angles for routine assessment are the neutral position, right rotated position, right rotated and extended position, right rotated and flexed position, extended position, flexed position, left rotated position, left rotated and extended position, and left rotated and flexed position.
See this image and copyright information in PMC

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