BOW HUNTER'S SYNDROME

MRA, CORONAL IMAGE HEAD IN NEUTRAL POSITION, DEMONSTRATES NORMAL SIZE OF LEFT VERTEBRAL ARTERY

MRA, HEAD ROTATED TO RIGHT AND HYPEREXTENDED, DEMONSTRATES NARROWING OF LEFT VERTEBRAL ARTERY AT C1-C2 LEVEL

BOW HUNTER'S SYNDROME DERIVES ITS NAME FROM THE POSITION THAT BOW HUNTERS USE, TURNING THEIR HEADS SIGNIFICANTLY TO ONE SIDE FOR SHOOTING.

THE ABOVE PATIENT IS A 58 YEAR OLD MALE. HIS SYMPTOMS WERE A ONE YEAR HISTORY OF FEELING DIZZY WHILE TURNING HIS HEAD TOWARDS THE RIGHT. SYMPTOMS WOULD DISAPPEAR WHEN HE TURNED HIS HEAD BACK TO A NEUTRAL POSITION.

THE MRA DEMONSTRATED SEVERELY STENOSED RIGHT VERTEBRAL ARTERY. DIAGNOSTIC ARTERIOGRAM WAS PERFORMED IN SEVERAL POSITIONS UNTIL THE PATIENT'S SYMPTOMS WERE DUPLICATED. THE ANGIOGRAM DEMONSTRATED NARROWING OF BOTH HORIZONTAL SEGMENTS OF THE LEFT VERTEBRAL LOOP AT THE LEVEL OF C1-C2.

THE PATIENT WAS SCHEDULED FOR SURGERY TO RELEASE SOFT TISSUES SURROUNDING THE LEFT VERTEBRAL ARTERY AT C1-C2 LEVEL.

BOW HUNTER'S SYNDROME USUALLY OCCUR WHEN ONE VERTEBRAL ARTERY IS OCCLUDED OR SEVERELY STENOSED. WHEN THE HEAD IS TURNED TOWARDS THE OCCLUDED ARTERY, THIS WILL STRETCH OR OCCLUDE THE OTHER SIDE LATERAL VERTEBRAL ARTERY. SINCE THIS CUTS OFF OR SLOWS BLOOD CIRCULATION IN THE VERTEBRAL ARTERIES, THE PATIENT WILL FEEL DIZZY AND MAY EXPERIENCE SYNCOPY, IF HEAD IS NOT RETURNED TO A NEUTRAL POSITION. THIS IS THEN A MECHANICAL PROBLEM AND IS ALLEVIATED BY RELEASING THE SOFT TISSUES AROUND THE VERTEBRAL ARTERY.

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