Hidden Bow Hunter's Syndrome Diagnosed Using Dynamic Cerebral Angiography and Successfully Treated with Spinal Surgery: A Case Report and Review of the Literature

Satoshi Miyamoto; Mikito Hayakawa; Sho Okune; Ryosuke Shintoku; Akinari Yamano; Takato Hiramine; Toshihide Takahashi; Hisayuki Hosoo; Yoshiro Ito; Aiki Marushima; Masao Koda; Eiichi Ishikawa; Yuji Matsumaru

doi:10.2169/internalmedicine.1386-22

Hidden Bow Hunter's Syndrome Diagnosed Using Dynamic Cerebral Angiography and Successfully Treated with Spinal Surgery: A Case Report and Review of the Literature

Intern Med. 2024 Jan 15;63(2):327-331. doi: 10.2169/internalmedicine.1386-22. Epub 2023 Jun 7.

Authors

Satoshi Miyamoto^{1

2}, Mikito Hayakawa^{1

3}, Sho Okune¹, Ryosuke Shintoku^{1

2}, Akinari Yamano^{1

2}, Takato Hiramine¹, Toshihide Takahashi^{1

2}, Hisayuki Hosoo^{1

2}, Yoshiro Ito^{1

2}, Aiki Marushima^{1

2}, Masao Koda⁴, Eiichi Ishikawa², Yuji Matsumaru^{1

2

3}

Affiliations

¹ Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan.
² Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan.
³ Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Japan.
⁴ Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Japan.

Abstract

Hidden bow hunter's syndrome (HBHS) is a rare disease in which the vertebral artery (VA) occludes in a neutral position but recanalizes in a particular neck position. We herein report an HBHS case and assess its characteristics through a literature review. A 69-year-old man had repeated posterior-circulation infarcts with right VA occlusion. Cerebral angiography showed that the right VA was recanalized only with neck tilt. Decompression of the VA successfully prevented stroke recurrence. HBHS should be considered in patients with posterior circulation infarction with an occluded VA at its lower vertebral level. Diagnosing this syndrome correctly is important for preventing stroke recurrence.

Keywords: bow hunter's syndrome; hidden bow hunter's syndrome; posterior circulation infarction; stroke causes.

Publication types

Review
Case Reports

MeSH terms

Aged
Cerebral Angiography / adverse effects
Humans
Male
Mucopolysaccharidosis II* / complications
Stroke* / complications
Vertebral Artery / diagnostic imaging
Vertebral Artery / surgery
Vertebrobasilar Insufficiency* / diagnostic imaging
Vertebrobasilar Insufficiency* / etiology
Vertebrobasilar Insufficiency* / surgery