Abstract
Bow hunter syndrome is a rare condition characterized by repetitive syncope, which is reflected in brain stem ischaemia due to vertebral compression induced by head rotation. We herein report a rare presentation of bow hunter syndrome due to severe stenosis of the left subclavian artery with a thoracic aortic aneurysm. Disease, hypoplasia of the vertebral artery, or degenerative bone disease as well as congenital foraminal narrowing can be causative. However, to our knowledge, this is the first report describing bow hunter syndrome due to severe stenosis of the left subclavian artery. Computed tomography angiography performed with the symptom induced by head rotation demonstrated obstruction of vertebral arteries. The patient underwent successful open-chest surgery and subclavian artery construction, and postural dizziness was resolved. This report may be helpful when treating similar cases.
A 74-year-old man presented to the cardiology department for consultation about syncope. He had experienced syncope several times induced by head turning. On examination, head turning to the right induced dizziness. Blood pressure was 124/98 mmHg in the right arm and 90/74 mmHg in the left arm. Contrast computed tomography revealed severe stenosis at the ostium of the left subclavian artery (Panel A and arrowheads) and a thoracic aortic aneurysm with a diameter of 70 mm with no aortic dissection (Panels B and C). Computed tomography angiography performed with the symptom induced by head rotation to the right demonstrated total obstruction of the left vertebral artery and severe stenosis of the right vertebral artery (Panel D, maximum intensity projection, arrows). Computed tomography angiography with the head in a neutral position revealed patent vertebral arteries (Panel E). A diagnosis of bow hunter syndrome—also called rotational vertebral artery syndrome—was made. Bow hunter syndrome is a rare but well-documented phenomenon of symptomatic vertebral compression by bony elements of the spine that occurs with physiologic head rotation. Disease, hypoplasia of the vertebral artery, or degenerative bone disease as well as congenital foraminal narrowing can be causative. The patient underwent successful open-chest surgery and subclavian artery reconstruction, and postural dizziness was resolved. The patient successfully underwent a total arch replacement procedure using an open stent graft, which led to the resolution of his postural dizziness.
Contributor Information
Hisaaki Komaki, Department of Cardiology, Gifu Municipal Hospital, 7-1 Kashima-Chou, Gifu 500-8323, Japan.
Shinya Minatoguchi, Department of Cardiology, Gifu Municipal Hospital, 7-1 Kashima-Chou, Gifu 500-8323, Japan.
Consent: The patient in this case report has been fully informed and has given their consent for the details of the case and associated images to be published.
Funding: None declared.
Data availability
No new data were generated or analysed in support of this research.
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
No new data were generated or analysed in support of this research.