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Jemin Yi, M.D.
, Ho Sung Han, M.D.*
, Ho Sung Han, M.D.*
Abstract
Bow hunter's syndrome is a rare disease that shows the symptoms of vertebrobasilar insufficiency resulting from a dynamic obstruction or stenosis of the vertebral arteries during neck movement. This paper reports a case of a 59-year-old male who visited the emergency room with diplopia, tinnitus, and gait disturbance. Magnetic resonance imaging and angiography revealed a multiple cerebellar infarct, total obstruction of the right vertebral artery, and dynamic obstruction of the left vertebral artery during neck extension. As the infarction worsened, a thrombectomy was done. Posterior decompression and fusion at C5-6 were performed for the left vertebral artery. The left vertebral arterial patency was confirmed by intraoperative and postoperative angiography. No recurrence of the symptoms was observed for six months after surgery. Physicians need to pay attention to the diagnosis of vertebrobasilar insufficiency caused by an obstruction of the vertebral arteries during neck extension in cervical instability patients.
Figures and Tables
Figure 1
Initial transfemoral cerebral angiography images show occlusion of the vertebral arteries. (A) The right vertebral artery is completely occluded at the C5-6 disc level (arrow). (B) The left vertebral artery is partially occluded by the C6 superior articular process (arrow).
Figure 2
Preoperative computed tomography angiography shows a blockade of circulation at the transverse foramina. (A) The right superior articular process completely occludes the right vertebral artery (arrow). (B) The left superior articular process occludes approximately 80% of the left C5 transverse foramen (arrow).
Figure 3
Intraoperative microscopy images show that the defect produced by left total facetectomy at C5 (white asterisk)-6 (black asterisk) was repaired by an interpositional bone graft using an auto iliac bone block (arrow).
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