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CC BY-NC-ND 4.0 · Asian J Neurosurg 2025; 20(01): 174-178
DOI: 10.1055/s-0044-1792160
Case Report

Bow–Hunter Syndrome Due to Tandem Lesions; A Case Report

Shigeomi Yokoya
1   Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
,
Jun Nakauchi
2   Department of Neurosurgery, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Setagaya, Tokyo, Japan
,
Hidesato Takezawa
3   Department of Neurology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
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Funding None.
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Abstract

Bow–Hunter syndrome (BHS) includes a form of stroke caused by dynamic factors affecting the extracranial vertebral artery (VA), such as rotation-induced flow disturbance at the atlantoaxial level. BHS is a rare condition that can result from a variety of factors, including abnormal bone compression and vertebral instability. So far, there have been no reports in which both vertebral instability and osteophytes compress the VA at different sites, leading to stroke. Herein, we present a rare case of stroke attributed to BHS involving thrombosis formation due to osteophyte compression at C3/4 and VA occlusion due to vertebral instability at the C4/5 overlapped. A 72-year-old male presented with rotational vertigo and vomiting associated with a cerebellar infarction. Digital subtraction angiography revealed severe stenosis of the left VA with an intra-arterial thrombus. Percutaneous transluminal angioplasty improved the stenosis; however, intravascular ultrasound revealed compression of the VA by osteophytes at C3/4. Additionally, left VA occlusion at C4/5 was confirmed because of vertebral instability. The osteophyte was removed via the anterolateral approach, and the VA was decompressed. The patient's postoperative course was uneventful, with no recurrence for more than 2 years. BHS can occur in the lower cervical spine when vertebral instability coincides with intimal arterial damage caused by osteophytes at other sites.

Keywords

Bow–Hunter syndrome - vertebral artery - intravascular ultrasound - osteophytes - vertebral instability

Note

This manuscript was presented at the 53rd Annual Meeting of the Japanese Society on Surgery for Cerebral Stroke on March 9, 2024.


Authors' Contributions

All authors contributed to the conception and design of the study. Material preparation and data collection were performed by all the authors. Data analysis was performed by S.Y. and J.N,. The first draft of the manuscript was written by S.Y., and all authors commented on the previous versions of the manuscript. All the authors have read and approved the final manuscript.


Ethical Approval

All procedures in this study were performed in accordance with the 1964 Declaration of Helsinki. A series of treatments were performed after obtaining appropriate written informed consent from the patient. The requirement for additional written consent for inclusion in this study was waived by the Ethics Committee of Saiseikai Shiga Hospital because of the retrospective and observational nature of the study (Permission Number; 646).




Publication History

Article published online:
04 November 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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