Skip to main content

Advertisement

Springer Nature Link
Log in

Bow hunter’s stroke due to instability at the uncovertebral C3/4 joint

  • Case Report
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Bow hunter’s stroke is typically due to mechanical compression or stretching of the dominant vertebral artery (VA) during contralateral head rotation against the bony elements of the atlas and axis. We report a case of vertebrobasilar insufficiency due to bilateral vertebral artery occlusion at the left C3–4 and the right C1–2 junction on rightward head rotation. A 64-year-old man experienced ischemic symptoms during 90° head rotation to the right with complete resolution of symptoms after returning his head to the neutral position. Dynamic cervical angiography with rightward head rotation showed severe compression of the right VA at the transverse foramen of C3–4 and mechanical stenosis of the left VA at the C1–2 level. During head rotation, the flow of the right VA was decreased more than the left side. Cervical 3-D computed tomography (CT) on rightward head rotation demonstrated displacement of the uncovertebral C3–4 joint, with excessive rotation of the C3 vertebral body. Based on these findings, instability at C3–4 was suspected to be the main cause of the vertebrobasilar insufficiency. Anterior discectomy and fusion at the C3/4 level were performed. Postoperatively, the patient experienced complete resolution of symptoms, and dynamic cervical angiography showed disappearance of the compression of the right VA. To our knowledge, this is the first reported case of bow hunter’s stroke diagnosed by dynamic cerebral angiography and cervical 3-D CT without angiography, and treated by anterior decompression and fusion without decompression of the VA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Sorensen BF (1978) Bow hunter’s stroke. Neurosurgery 2:259–261

    Article  PubMed  CAS  Google Scholar 

  2. Matsuyama T, Morimoto T, Sakaki T (1997) Bow Hunter’s stroke caused by a nondominant vertebral artery occlusion: case report. Neurosurgery 41:1393–1395

    Article  PubMed  CAS  Google Scholar 

  3. Kimura T, Sako K, Tohyama Y, Hodozuka A (1999) Bow Hunter’s stroke caused by simultaneous occlusion of both vertebral arteries. Acta Neurochir (Wien) 141:895–896

    Article  CAS  Google Scholar 

  4. Gomi M, Hattori I, Horikawa F, Iwasaki K (2006) A case of bow hunter’s stroke treated with endovascular surgery. No Shinkei Geka 34:189–192

    PubMed  Google Scholar 

  5. Horowitz M, Jovin T, Balzar J, Welch W, Kassam A (2002) Bow hunter’s syndrome in the setting of contralateral vertebral artery stenosis: evaluation and treatment options. Spine 27:E495–E498

    Article  PubMed  Google Scholar 

  6. Seki T, Hida K, Akino M, Iwasaki Y (2001) Anterior decompression of the atlantoaxial vertebral artery to treat bow hunter’s stroke: technical case report. Neurosurgery 49:1474–1476

    Article  PubMed  CAS  Google Scholar 

  7. Wakayama K, Murakami M, Suzuki M, Ono S, Shimizu N (2005) Ischemic symptoms induced by occlusion of the unilateral vertebral artery with head rotation together with contralateral vertebral artery dissection–case report. J Neurol Sci 236:87–90

    Article  PubMed  Google Scholar 

  8. Bulsara KR, Velez DA, Villavicencio A (2006) Rotational vertebral artery insufficiency resulting from cervical spondylosis: case report and review of the literature. Surg Neurol 65:625–627

    Article  PubMed  Google Scholar 

  9. Kawaguchi T, Fujita S, Hosoda K, Shibata Y, Iwakura M, Tamaki N (1997) Rotational occlusion of the vertebral artery caused by transverse process hyperrotation and unilateral apophyseal joint subluxation: case report. J Neurosurg 86:1031–1035

    Article  PubMed  CAS  Google Scholar 

  10. Shinohara N, Kohno K, Takeda S, Ohta S, Sakaki S (1998) A case of bow hunter’s stroke caused by bilateral vertebral artery occlusive change on head rotation to the right. No Shinkei Geka 26:417–422

    PubMed  CAS  Google Scholar 

  11. Tsutsumi S, Ito M, Yasumoto Y (2008) Simultaneous bilateral vertebral artery occlusion in the lower cervical spine manifesting as bow hunter’s syndrome. Neurol Med Chir (Tokyo) 48:90–94

    Article  Google Scholar 

  12. Vates GE, Wang KC, Bonovich D, Dowd CF, Lawton MT (2002) Bow hunter stroke caused by cervical disc herniation. Case report. J Neurosurg 96(1 Suppl):90–93

    PubMed  Google Scholar 

  13. Matsuyama T, Morimoto T, Sakaki T (1997) Usefulness of three-dimensional CT for bow hunter stroke. Acta Neurochir (Wien) 139:265–266

    Article  CAS  Google Scholar 

  14. Kotani Y, McNulty PS, Abumi K, Cunningham BW, Kaneda K, McAfee PC (1998) The role of anteromedial foraminotomy and the uncovertebral joints in the stability of the cervical spine. A biomechanical study. Spine 23:1559–1565

    Article  PubMed  CAS  Google Scholar 

  15. Oh SH, Perin NI, Cooper PR (1996) Quantitative three-dimensional anatomy of the subaxial cervical spine: implication for anterior spinal surgery. Neurosurgery 38:1139–1144

    PubMed  CAS  Google Scholar 

  16. Hayashi K, Matsuo T, Kurihara M, Shibata S (2000) A case of juvenile bow hunter’s stroke. No To Shinkei 52:431–434

    PubMed  CAS  Google Scholar 

  17. Shimizu T, Waga S, Kojima T, Niwa S (1988) Decompression of the vertebral artery for bow-hunter’s stroke. Case report. J Neurosurg 69:127–131

    Article  PubMed  CAS  Google Scholar 

  18. Hanakita J, Miyake H, Nagayasu S, Nishi S, Suzuki T (1988) Angiographic examination and surgical treatment of bow hunter’s stroke. Neurosurgery 23:228–232

    Article  PubMed  CAS  Google Scholar 

  19. Velat GJ, Reavey-Cantwell JF, Ulm AJ, Lewis SB (2006) Intraoperative dynamic angiography to detect resolution of Bow Hunter’s syndrome: technical case report. Surg Neurol 66:420–423 discussion 423

    Article  PubMed  Google Scholar 

  20. Netuka D, Benes V, Mikulik R, Kuba R (2005) Symptomatic rotational occlusion of the vertebral artery–case report and review of the literature. Zentralbl Neurochir 66:217–222

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None of the authors has any potential conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Kazuhiro Yoshimura, Koichi Iwatsuki, Masahiro Ishihara, Yu-ichirou Onishi, Masao Umegaki & Toshiki Yoshimine

Authors
  1. Kazuhiro Yoshimura
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Koichi Iwatsuki
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Masahiro Ishihara
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Yu-ichirou Onishi
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Masao Umegaki
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Toshiki Yoshimine
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Kazuhiro Yoshimura.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yoshimura, K., Iwatsuki, K., Ishihara, M. et al. Bow hunter’s stroke due to instability at the uncovertebral C3/4 joint. Eur Spine J 20 (Suppl 2), 266–270 (2011). https://doi.org/10.1007/s00586-010-1669-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-010-1669-2

Keywords