A 60-year-old woman with a 37-year history of rheumatoid arthritis (RA) had a sudden onset of headache. Head MRI showed acute multiple infarctions in the vertebrobasilar region, and MR angiography showed stenosis of the right vertebral artery (VA). 3D-CT angiography of the craniovertebral junction showed atlantoaxial subluxation and stenosis of the right VA just distal to the transverse foramen of C2, which was due to osteophytes and degenerative changes secondary to RA. Digital subtraction angiography clearly demonstrated occlusion of the right VA during rightward head rotation. Based on those findings, rotatory instability at C1-2 was considered as the primary cause of the vertebrobasilar infarctions, and Bow Hunter's syndrome was diagnosed. The patient underwent C1-5 posterior fixation, and brain infarction has not recurred.
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Article Synopsis
- Bow hunter's stroke (BHS) occurs when the vertebral artery gets compressed during head rotation, leading to temporary neurological issues and a risk of stroke.
- A case study of a 25-year-old woman who developed multiple cerebral infarctions after sleeping with her head rotated showed that her vertebral artery was affected by this position.
- The treatment involved a surgical procedure to stabilize the cervical vertebrae, which successfully prevented further incidents, highlighting the importance of considering sleep position in similar cases.
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