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Case Reports
. 2021 Dec 4;13(12):e20167.
doi: 10.7759/cureus.20167. eCollection 2021 Dec.

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

Mohammed K Bukhari  1   2 , Saeed A Alghamdi  3   1   2
Affiliations
Case Reports

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

Mohammed K Bukhari et al. Cureus. .

Abstract

Ischemic stroke secondary to dynamic vertebral artery stenosis or occlusion, also known as "bow hunter's syndrome," is a rare stroke mechanism. We report a case of a 24-year-old man with multiple hereditary exostosis (MHE) diagnosed at childhood. His first presentation to a neurologist was due to neck pain and clinical syndrome suggestive of ischemia in the vertebrobasilar territory. A therapeutic occlusion was done successfully without complication. The patient was discharged two days later on aspirin alone. In follow up one year later he continued to be symptom free. Moreover, this stroke mechanism has been reported extensively in the literature in isolation or secondary to many underlying diseases. In total, there are 168 cases reported in the published English literature, in either case reports or small series. In this review, we found that by far, vertebral artery occlusion at the atlanto-axial (C1-2) level dominated most reported cases. The most frequent presentation that led to further investigation was syncope or pre-syncope provoked by head rotation to one side. To our knowledge, there is no previous report of any stroke syndrome related to MHE before our case. In this paper, we report the first case secondary to MHE and review the literature up to date since the first reported case in 1952.

Keywords: bow hunter syndrome; dynamic vertebral artery stenosis; ischemic stroke; stroke; vertebral artery compression; vertebral artery occlusion.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CT angiography (CTA) axial view shows severe narrowing of the left vertebral artery at C2 level with possible dissection (arrow).
Figure 2
Figure 2. CT angiography (CTA) coronal view, shows severe narrowing of the left vertebral artery at C2 level with possible dissection (arrow).
Figure 3
Figure 3. MRI of the brain with diffusion-weighted images (DWI) shows small infarctions at the left cerebellum.
Figure 4
Figure 4. MRI of the brain with T2 weighted image shows small infarctions at the right thalamus.
Figure 5
Figure 5. Cerebral angiogram with head in the neutral position.
Figure 6
Figure 6. Cerebral angiogram with the head rotated to the right shows the dynamic stenosis of the left vertebral artery on head-turning (arrow).
See this image and copyright information in PMC

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References

    1. Dissections of brain-supplying arteries. Caplan LR. Nat Clin Pract Neurol. 2008;4:34–42. - PubMed
    1. Bow hunter's stroke. Sorensen BF. Neurosurgery. 1978;2:259–261. - PubMed
    1. Rotational vertebral artery compression : bow hunter's syndrome. Go G, Hwang SH, Park IS, Park H. J Korean Neurosurg Soc. 2013;54:243–245. - PMC - PubMed
    1. Aetiological diagnosis of ischaemic stroke in young adults. Ferro JM, Massaro AR, Mas JL. Lancet Neurol. 2010;9:1085–1096. - PubMed
    1. Mechanical compression of the extracranial vertebral artery during neck rotation. Sakaguchi M, Kitagawa K, Hougaku H, et al. Neurology. 2003;61:845–847. - PubMed

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