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Takeshima Y, Motoyama Y, Nakagawa I, Eura N, Saito K, Sugie K, Nakase H. Embolic stroke induced by rotational persistent 1st intersegmental artery compression. Br J Neurosurg 2023; 37:1835-1838. [PMID: 34180319 DOI: 10.1080/02688697.2021.1940854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
A 45-year-old man suffered multiple cerebral infarctions in the vertebrobasilar artery territory, followed by second stroke against conservative treatment. Radiological examinations revealed intra-arterial defect in left persistent 1st intersegmental artery (PFIA) at C1 level, suggesting mural thrombus, and mechanical compression of left PFIA at the level with head rotation to the right clearly revealed by reconstructed 3-dimensional radiological images, but no findings of atlantoaxial instability. One month after the second stroke, posterior fixation was performed. Postoperative course was uneventful without subsequent stroke for 24 months. This unique case demonstrated that PFIA might associate with cerebral stroke as a clinical condition of bow hunter's stroke even in middle age. Reconstructed 3-dimensional radiological images might be useful for clear demonstration of the pathophysiology in this complex clinical entity.
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Affiliation(s)
- Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Nobuyuki Eura
- Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kozue Saito
- Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kazuma Sugie
- Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
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Sato M, Yamahata H, Yasuda M, Hiwatari T, Yonenaga M, Ishimaru K, Miyanohara O, Shimozuru T, Yoshimoto K. Treatment of rotational/positional vertebral artery occlusion due to degenerative changes in the cervical vertebrae: A case report and review of the literature. J Orthop Sci 2023; 28:1614-1619. [PMID: 35078705 DOI: 10.1016/j.jos.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/21/2021] [Accepted: 12/23/2021] [Indexed: 02/09/2023]
Affiliation(s)
- Masanori Sato
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan.
| | - Hitoshi Yamahata
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Muneyoshi Yasuda
- Division of Neurosurgery, Ichinomiyanishi Hospital, Ichinomiya,1 Kaimeihira, Ichinomiya-shi, Aichi, 494-0001, Japan
| | - Takaaki Hiwatari
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Masanori Yonenaga
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Koichi Ishimaru
- Division of Neurosurgery, Kushikino Neurosurgical Center, 5391-3, Seifuku, Ichikikushikino-shi, Kagoshima, 896-0078, Japan
| | - Osamu Miyanohara
- Division of Neurosurgery, Kushikino Neurosurgical Center, 5391-3, Seifuku, Ichikikushikino-shi, Kagoshima, 896-0078, Japan
| | - Tetsuro Shimozuru
- Division of Neurosurgery, Kushikino Neurosurgical Center, 5391-3, Seifuku, Ichikikushikino-shi, Kagoshima, 896-0078, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
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A Surgical Case of Bow Hunter’s Syndrome Diagnosed by Cervical Rotational MRA. Case Rep Orthop 2022; 2022:6091597. [PMID: 35966221 PMCID: PMC9371809 DOI: 10.1155/2022/6091597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/16/2022] [Indexed: 11/18/2022] Open
Abstract
Bow hunter's syndrome is an ischemic manifestation of vertebrobasilar artery (VA) insufficiency due to stenosis or occlusion of the contralateral VA at the bony elements of the atlas and axis during neck rotation. In early reports, VA stenosis at the craniovertebral junction was the main cause, but later, symptoms due to VA occlusion at the middle and lower cervical vertebrae were also included in this pathology. Although the confirmed diagnosis is usually determined by dynamic digital subtraction angiography (DSA), we have experienced a method of minimally invasive MR angiogram (MRA) that provides the same diagnostic value as DSA and would like to present it here. The patient was a 61-year-old man who had been visiting the outpatient clinic for cervical spondylosis due to neck pain for 9 months. When he rotated his neck to the left side, dizziness and syncope appeared. Initial MRA in the neutral position did not show any steno-occlusive changes in the vertebrobasilar artery. In our hospital, repeated MRA with the neck rotated 45 degrees to the left demonstrated ipsilateral left VA severe stenosis. Subsequent DSA showed the same findings, with occlusion of the left VA. CT of the cervical spine revealed a ventral C3/4 osteophyte within the foramen. Based on these findings, instability at the C3-4 during head rotation was considered the cause of the vertebrobasilar insufficiency. The patient underwent anterior discectomy and fusion (ACDF) at the C3/4 level using a cylindrical titanium cage. Immediately after the surgery, the patient's symptoms improved dramatically and did not appear even when the neck were fully rotated to the left. More than 5 years have passed since the surgery, and the patient is still in good health.
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Shingai Y, Sakata H, Endo T, Suzuki S, Ezura M, Tominaga T. Bow hunter's syndrome due to an embolic mechanism: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE20150. [PMID: 36046772 PMCID: PMC9394226 DOI: 10.3171/case20150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND Bow hunter's syndrome (BHS) is an uncommon cause of vertebrobasilar ischemic stroke, which results from occlusion or injury to the vertebral artery (VA) during neck rotation. Although hemodynamic insufficiency is the predominant underlying mechanism of this entity, BHS due to embolic mechanisms is rare. The authors report a case of BHS characterized by repeated posterior circulation embolism and present some considerations of BHS with an embolic mechanism. OBSERVATIONS A 57-year-old man suffered from repeated embolic stroke in the posterior circulation. Digital subtraction angiography revealed caliber irregularity of the V3 segment of the left nondominant-side VA, which occluded when the neck rotated to the right side. The patient was diagnosed with BHS with an embolic mechanism due to endothelial damage caused by osteophytes at the C1 foramen transversarium. After C1-C2 fusion surgery, the patient never experienced the recurrence of stroke. According to a literature review, BHS due to embolic mechanisms tends to occur in young male adults, manifesting as recurrent stroke in the posterior circulation. Involvement of the nondominant-side VA can cause BHS with an underlying embolic mechanism. LESSONS BHS due to an embolic mechanism should be considered as a differential diagnosis if patients have repeated embolic strokes in the posterior circulation.
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Affiliation(s)
- Yuto Shingai
- Department of Neurosurgery, National Hospital Organization
Sendai Medical Center, Sendai, Japan; and
| | - Hiroyuki Sakata
- Department of Neurosurgery, National Hospital Organization
Sendai Medical Center, Sendai, Japan; and
| | - Toshiki Endo
- Department of Neurosurgery, National Hospital Organization
Sendai Medical Center, Sendai, Japan; and
| | - Shinsuke Suzuki
- Department of Neurosurgery, National Hospital Organization
Sendai Medical Center, Sendai, Japan; and
| | - Masayuki Ezura
- Department of Neurosurgery, National Hospital Organization
Sendai Medical Center, Sendai, Japan; and
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of
Medicine, Sendai, Japan
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Eura N, Saito K, Shimizu H, Takeshima Y, Shima M, Kichikawa K, Nakase H, Sugie K. A thromboembolic mechanism in bow hunter's stroke: Importance of hemodynamic evaluation by ultrasonography during head rotation. eNeurologicalSci 2020; 20:100254. [PMID: 32715110 PMCID: PMC7369583 DOI: 10.1016/j.ensci.2020.100254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/04/2020] [Indexed: 01/17/2023] Open
Affiliation(s)
- Nobuyuki Eura
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Nara, Japan
- Corresponding author at: Department of Neurology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan.
| | - Kozue Saito
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Hironori Shimizu
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Midori Shima
- Department of Thrombosis and Hemostasis Research Center, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Nara, Japan
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Bow Hunter's Syndrome Caused by Compression of the Subaxial Vertebral Artery: Surgical Technique of Anterolateral Decompression (video). World Neurosurg 2018; 119:358-361. [DOI: 10.1016/j.wneu.2018.08.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 12/29/2022]
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