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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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Bono BC, Riva M, Pessina F. Cerebellar Ischemic Stroke Secondary to Rotational Non-Dominant Vertebral Artery Occlusion (RVAO): A Rare Complication Following Supratentorial Surgery. Asian J Neurosurg 2023; 18:206-209. [PMID: 37056908 PMCID: PMC10089759 DOI: 10.1055/s-0043-1763527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
AbstractNon-traumatic vertebrobasilar stroke syndrome is rare. Many etiological mechanisms have been described over the years, with the dynamic occlusion of one vertebral artery following head rotation (RVAO) being one of them. We report the case of a patient undergoing surgery for supratentorial metastasis, who postoperatively developed a cerebellar ischemic stroke secondary to RVAO. Postoperative imaging showed a right hypoplastic VA; so, a transient occlusive mechanism was thought to be responsible for the postoperative cerebellar stroke. Although rare, RVAO can occur following head rotation during patient positioning for neurosurgical procedures.
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Kutsuna F, Morofuji Y, Shiozaki E, Uchida D, Tokuda M, Iwanaga H, Ono T, Kawahara I, Haraguchi W, Tsutsumi K. Endovascular Coil Embolization for Recurrent Bow Hunter's Stroke. Intern Med 2022; 61:3595-3598. [PMID: 35569978 PMCID: PMC9790794 DOI: 10.2169/internalmedicine.8906-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Bow hunter's stroke is a rare cause of vertebrobasilar infarction. There is no consensus regarding the optimal treatment. We herein report a case of bow hunter's stroke successfully treated by endovascular treatment. A 70-year-old man presented with central vertigo. Magnetic resonance imaging (MRI) showed posterior circulation infarcts. Dynamic angiography revealed thrombus formation and hypoperfusion of the right vertebral artery upon head rotation to the left. Endovascular parent artery occlusion of the right vertebral artery was performed, and there was no recurrence at follow-up MRI. Endovascular parent artery occlusion might be a useful treatment for bow hunter's stroke.
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Affiliation(s)
- Fumiya Kutsuna
- Department of Neurology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Yoichi Morofuji
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Japan
| | - Eri Shiozaki
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Japan
| | - Daiki Uchida
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Japan
| | - Masahiro Tokuda
- Department of Neurology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Hiroshi Iwanaga
- Department of Neurology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Tomonori Ono
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Japan
| | - Ichiro Kawahara
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Japan
| | - Wataru Haraguchi
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Japan
| | - Keisuke Tsutsumi
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Japan
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Bukhari MK, Alghamdi SA. Ischemic Stroke Secondary to Dynamic Vertebral Artery Stenosis: Case Report and Review of the Literature. Cureus 2021; 13:e20167. [PMID: 35003995 PMCID: PMC8724019 DOI: 10.7759/cureus.20167] [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] [Accepted: 12/04/2021] [Indexed: 11/24/2022] Open
Abstract
Ischemic stroke secondary to dynamic vertebral artery stenosis or occlusion, also known as “bow hunter's syndrome,” is a rare stroke mechanism. We report a case of a 24-year-old man with multiple hereditary exostosis (MHE) diagnosed at childhood. His first presentation to a neurologist was due to neck pain and clinical syndrome suggestive of ischemia in the vertebrobasilar territory. A therapeutic occlusion was done successfully without complication. The patient was discharged two days later on aspirin alone. In follow up one year later he continued to be symptom free. Moreover, this stroke mechanism has been reported extensively in the literature in isolation or secondary to many underlying diseases. In total, there are 168 cases reported in the published English literature, in either case reports or small series. In this review, we found that by far, vertebral artery occlusion at the atlanto-axial (C1-2) level dominated most reported cases. The most frequent presentation that led to further investigation was syncope or pre-syncope provoked by head rotation to one side. To our knowledge, there is no previous report of any stroke syndrome related to MHE before our case. In this paper, we report the first case secondary to MHE and review the literature up to date since the first reported case in 1952.
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Kano Y, Sato C, Uchida Y, Muto M, Sakurai K, Inoue H, Kitamura T, Miura T, Yamada K, Matsukawa N. A Case of Posterior Circulation Embolism Due to a Subtype of Bow Hunter's Syndrome Diagnosed by Non-Invasive Examination. J Stroke Cerebrovasc Dis 2021; 31:106178. [PMID: 34794030 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 10/19/2022] Open
Abstract
Bow hunter's syndrome is the mechanical compression of the vertebral artery due to cervical rotation, resulting in ischemic symptoms in the vertebrobasilar artery territory. However, some cases present without typical symptoms and exhibit compression of the non-dominant side of the vertebral artery. We encountered a case of posterior circulation embolism due to a subtype of bow hunter's syndrome in a 74-year-old man. Although the right vertebral artery was not visualized on time-of-flight magnetic resonance angiography in the neutral position, duplex ultrasonography and time-of-flight magnetic resonance angiography in the left cervical rotation position showed blood flow in the right vertebral artery. In this case, blood flow in the contralateral vertebral artery was normal, and typical bow hunter's syndrome symptoms did not occur. In a case of posterior circulation embolism with undetermined etiology, wherein the routine duplex ultrasonography and time-of-flight magnetic resonance angiography results were inconclusive, additional testing with head positioning led to the diagnosis of a subtype of bow hunter's syndrome.
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Affiliation(s)
- Yuya Kano
- Department of Neurology, Nagoya City University East Medical Center, Aichi, Japan.
| | - Chikako Sato
- Department of Neurology, Nagoya City Rehabilitation Center, Aichi, Japan.
| | - Yuto Uchida
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan; Department of Neurology, Toyokawa City Hospital, Aichi, Japan.
| | - Masahiro Muto
- Department of Radiology, Nagoya City University East Medical Center, Aichi, Japan.
| | - Keita Sakurai
- Department of Radiology, National Center for Geriatrics and Gerontology, Aichi, Japan.
| | - Hiroyasu Inoue
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
| | - Taro Kitamura
- Department of Neurology, Nagoya City University East Medical Center, Aichi, Japan.
| | - Toshiyasu Miura
- Department of Neurology, Nagoya City University East Medical Center, Aichi, Japan.
| | - Kentaro Yamada
- Department of Neurology, Nagoya City University East Medical Center, Aichi, Japan.
| | - Noriyuki Matsukawa
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Aichi, 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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Tanaka K, Steinfort B. Rare cause of Bow Hunter's syndrome due to an aberrant course of a vertebral artery. BMJ Case Rep 2019; 12:12/7/e229584. [PMID: 31340945 DOI: 10.1136/bcr-2019-229584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bow Hunter's syndrome (BHS) is a rare cause of vertebrobasilar insufficiency and is reported to most commonly be caused by vertebral artery impingement on cervical vertebrae osteophytes. We report a case in a 56-year-old male patient who on investigation of recurrent posterior circulation ischaemic strokes was found to have BHS. The aetiology of the syndrome in this patient is due to a particularly unusual aberrancy in the path of the atlantoaxial portion of the culprit left vertebral artery. Aberrancy of the distal portion of the vertebral artery is in itself a rare entity, and there are few reports of it in relation to BHS. The patient in this case was successfully treated with endovascular sacrifice of the vertebral artery with no further dynamic occlusive symptoms.
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Affiliation(s)
- Kaishin Tanaka
- Interventional Neuroradiology, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - Brendan Steinfort
- Neurosurgery, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
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Favorable Long-Term Outcomes for Positional Vertebral Artery Occlusion with Treatment Strategy Prioritizing Spinal Fusion Surgery. World Neurosurg 2018; 114:e792-e799. [DOI: 10.1016/j.wneu.2018.03.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/10/2018] [Accepted: 03/12/2018] [Indexed: 11/22/2022]
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Duan G, Xu J, Shi J, Cao Y. Advances in the Pathogenesis, Diagnosis and Treatment of Bow Hunter's Syndrome: A Comprehensive Review of the Literature. INTERVENTIONAL NEUROLOGY 2016; 5:29-38. [PMID: 27610119 DOI: 10.1159/000444306] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Bow hunter's syndrome (BHS), also known as rotational vertebral artery (VA) occlusion syndrome, is a rare yet treatable type of symptomatic vertebrobasilar insufficiency resulting from mechanical occlusion or stenosis of the VA during head and neck rotation or extension. The symptoms of BHS range from transient vertigo to posterior circulation stroke. The underlying pathology is dynamic stenosis or compression of the VA by abnormal bony structures with neck rotation or extension in many cases, such as osteophyte, disc herniation, cervical spondylosis, tendinous bands or tumors. Imaging approaches, such as Doppler sonography, computed tomography and angiography, as well as magnetic resonance imaging and angiography, are widely used in the diagnosis and evaluation of this syndrome. Digital subtraction angiography with head rotation remains the gold standard diagnostic method. Conservative management, surgery and endovascular procedures are the three major treatment methods for BHS, whereas some symptomatic patients may need operative treatment including surgery and endovascular procedures when conservative management is not adequate.
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Affiliation(s)
- Guangxin Duan
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiaping Xu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jijun Shi
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongjun Cao
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Translational Research and Therapy for Neuro-Psycho-Diseases, Institute of Neuroscience, Soochow University, Suzhou, China
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Takekawa H, Suzuki K, Nishihira T, Iwasaki A, Hoshiyama E, Okamura M, Numao A, Suzuki S, Hirata K. Recurrent juvenile ischemic stroke caused by bow hunter's stroke revealed by carotid duplex ultrasonography. J Med Ultrason (2001) 2015; 42:437-40. [PMID: 26576800 DOI: 10.1007/s10396-015-0611-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/24/2014] [Indexed: 11/25/2022]
Abstract
Bow hunter's stroke (BHS) is a rare cause of vertebrobasilar insufficiency due to rotational vertebral artery (VA) occlusion associated with head turning. We report a juvenile patient presenting with recurrent ischemic stroke caused by BHS, which was revealed by carotid duplex ultrasonography. Carotid duplex ultrasonography performed in the neutral position showed normal findings. However, disappearance of end-diastolic blood flow of contralateral VAs was observed with head rotation. Digital subtraction angiography confirmed occlusion at C1/2 levels in the VA contralateral to the head rotation, bilaterally. Importantly, our patient did not recognize the association of head rotation and previous episodes of stroke. We suggest that BHS should be considered in patients with cryptogenic stroke occurring in the vertebrobasilar artery territory.
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Affiliation(s)
- Hidehiro Takekawa
- Stroke Division, Department of Neurology, Dokkyo Medical University, Tochigi, Japan
- Center of Medical Ultrasonics, Dokkyo Medical University, Tochigi, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Takahito Nishihira
- Stroke Division, Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Akio Iwasaki
- Stroke Division, Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Eisei Hoshiyama
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Madoka Okamura
- Stroke Division, Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Ayaka Numao
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Shiho Suzuki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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Endovascular Embolization of a Nondominant Vertebral Artery Compressed by an Osteophyte to Prevent Recurrence of Vertebrobasilar Infarctions. J Stroke Cerebrovasc Dis 2015; 24:e257-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/07/2015] [Accepted: 05/19/2015] [Indexed: 12/14/2022] Open
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Rheumatoid arthritis-induced lateral atlantoaxial subluxation with multiple vertebrobasilar infarctions. Spine (Phila Pa 1976) 2015; 40:E186-9. [PMID: 25384055 DOI: 10.1097/brs.0000000000000701] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To highlight the probability that lateral atlantoaxial subluxation (AAS) exists in patients with rheumatoid arthritis (RA) and induces vertebrobasilar infarctions that are more foregrounded than compressive myelopathy. SUMMARY OF BACKGROUND DATA Although lateral subluxation is a well-known subtype of AAS, a case of cerebral ischemia associated with lateral AAS has not been reported before. METHODS A 52-year-old male with a 6-year history of RA had a sudden onset of visual field defect and mild right cerebellar ataxia. Head magnetic resonance imaging revealed acute multiple infarctions in the vertebrobasilar area, and magnetic resonance angiography revealed stenosis of the left vertebral artery (VA). Lateral radiograph of the cervical spine in the neutral position revealed atlanto-occipital assimilation and anterior AAS. T2-weighted sagittal images on cervical magnetic resonance imaging revealed high signal intensity in the spinal cord at C1-C2. Cerebral angiography revealed right VA occlusion and severe stenosis of the left V3 segment of VA. Three-dimensional computed tomography angiography of the craniovertebral junction revealed lateral AAS, which was due to severe erosive changes of the facet joints, and the left V3 portion was stenosed by a bony component. During conservative therapy, the patient experienced left occulomotor nerve palsy due to a second stroke. RESULTS Two months later, the patient underwent occipitocervical posterior fusion with an iliac bone graft. His postoperative course was uneventful, and the left VA stenosis disappeared. At the 45-month follow-up, he had no further infarctions. Bony fusion was radiologically confirmed, and 3-dimensional computed tomography angiography revealed good patency of the affected left VA. CONCLUSION In patients with RA, the potential risk of AAS should be recognized. Lateral AAS in particular may induce cerebral ischemia by positional VA occlusion in advanced stages of the disease. LEVEL OF EVIDENCE N/A.
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Yamaguchi S, Horie N, Tsunoda K, Tateishi Y, Izumo T, Hayashi K, Tsujino A, Nagata I. Bow Hunter's Stroke Due to Stretching of the Vertebral Artery Fenestration: A Case Report. NMC Case Rep J 2014; 2:9-11. [PMID: 28663954 PMCID: PMC5364926 DOI: 10.2176/nmccrj.2014-0075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/27/2014] [Indexed: 12/16/2022] Open
Abstract
Bow Hunter’s syndrome is an unusual symptomatic vertebrobasilar insufficiency resulting from intermittent mechanical compression of the vertebral artery, and is rarely a trigger for cerebral infarction following thrombus formation on the damaged endothelial vessels (Bow Hunter’s stroke). The authors present an extremely rare case of a 45-year-old man showing Bow Hunter’s stroke due to congenital vertebral artery fenestration stretching and sliding between C1 and C2 after head rotation to the right. Congenital vertebral artery anomaly rarely causes cerebral infarction, but could cause embolic strokes by mechanical stretching without bony abnormalities.
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Affiliation(s)
- Susumu Yamaguchi
- Department of Neurosurgery, Nagasaki University School of Medicine, Sakamoto, Nagasaki
| | - Nobutaka Horie
- Department of Neurosurgery, Nagasaki University School of Medicine, Sakamoto, Nagasaki
| | - Keishi Tsunoda
- Department of Neurosurgery, Nagasaki University School of Medicine, Sakamoto, Nagasaki
| | - Yohei Tateishi
- Department of Stroke Center, Nagasaki University School of Medicine, Sakamoto, Nagasaki
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University School of Medicine, Sakamoto, Nagasaki
| | - Kentaro Hayashi
- Department of Neurosurgery, Nagasaki University School of Medicine, Sakamoto, Nagasaki
| | - Akira Tsujino
- Department of Stroke Center, Nagasaki University School of Medicine, Sakamoto, Nagasaki
| | - Izumi Nagata
- Department of Neurosurgery, Nagasaki University School of Medicine, Sakamoto, Nagasaki
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Fusion surgery for recurrent cerebellar infarctions due to bilateral atlantoaxial rotational vertebral artery occlusion. Spine (Phila Pa 1976) 2014; 39:E860-3. [PMID: 24918470 DOI: 10.1097/brs.0000000000000341] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report and literature review. OBJECTIVE To describe a unique case of recurrent cerebral embolisms with "bilateral" atlantoaxial rotational vertebral artery occlusion (RVAO), and review the literature on this rare entity. SUMMARY OF BACKGROUND DATA The few reports of bilateral bow hunter's stroke (BHS) contain either RVAO at the subaxial level, and BHS associated with bilateral RVAO at the atlantoaxial level has never been reported. The treatment strategy for this entity is controversial. METHODS An 18-year-old female experienced a cerebellar embolism in the left superior cerebellar artery area, followed by a second cerebral embolism in the right posterior inferior cerebellar artery area. Blood analysis showed no coagulation or autoimmune abnormalities. Transesophageal echocardiography ruled out a patent foramen ovale. Vertebral angiography and 3-dimensional computed tomography angiography with neck rotation clearly showed vertebral artery occlusion at the atlantoaxial level. For preventing a recurrence of thromboembolic event, surgical intervention was chosen. RESULTS The patient underwent posterior atlantoaxial fixation with an iliac bone graft 2 months after the previous cerebellar infarction. Her postoperative course was uneventful. At 22 months of follow-up, she had no neurological deficits or further infarctions. Bony fusion was radiologically confirmed and 3-dimensional computed tomography angiography with neck rotation showed good patency of vertebral arteries. CONCLUSION To our knowledge, the 7 published reports of bilateral BHS or RVAO involve double causes both the atlantoaxial and subaxial levels, but 1 unspecified case. Because of the difficulty to identify the proper affected side in the case of bilateral atlantoaxial BHS with certainty, fusion surgery may be suitable for the reliable treatment. LEVEL OF EVIDENCE N/A.
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Abstract
PURPOSE We describe here the axis dysmorphism that we observed in the skeletal remains of a human child dug up from a fifteenth century cemetery located in north-eastern Italy. This bone defect is discussed in the light of pertinent literature. METHODS We performed macroscopical examination and CT scan analysis of the axis. RESULTS Axis structure was remarkably asymmetric. Whilst the left half exhibited normal morphology, the right one was smaller than normal, and its lateral articular surface showed horizontal orientation. In addition, the odontoid process appeared leftward deviated and displayed a supplementary articular-like facet situated on the right side of its surface. CONCLUSIONS These findings suggest a diagnosis of unilateral irregular segmentation of atlas and axis, a rare dysmorphism dependent upon disturbances of notochordal development in early embryonic life. Likewise other malformations of the craniovertebral junction, this axis defect may alter the delicate mechanisms of upper neck movements and cause a complex series of clinical symptoms. This is an emblematic case whereby human skeletal remains may provide valuable information on the anatomical defects of craniovertebral junction.
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