Bow Hunter's Syndrome (rotational vertebral artery occlusion syndrome) is a rare vascular disorder caused by a severe reduction in blood flow in a vertebral artery.


Clinical signs and symptoms may include:

(1) presyncope or syncope

(2) vertigo or dizziness

(3) double vision

(4) headache

(5) paresthesias

(6) nausea and vomiting

(7) nystagmus

(8) hemiparesis

(9) loss of consciousness

(10) swallowing difficulties

(11) acute posterior stroke


The symptoms are precipitated by rotation of the head within the normal physiologic range.


The diagnosis is usually made by imaging of the posterior circulation before and during neck rotation:

(1) dynamic vertebral angiography

(2) CT angiography

(3) magnetic resonance angiography

(4) ultrasonography


Decompression of the vertebral artery should relieve the signs and symptoms.


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