Posterior circulation stroke: bow hunter’s syndrome (BHS)

Pathology

• This is rotational vertebral artery occlusion syndrome
• The vertebral artery occludes during head or neck rotation
• Head rotation to the contralateral side triggers symptoms in >50% of cases
• It may also occur during neck extension
• Most occlusions are at C1-2 or C5-7 vertebral levels
• The left vertebral artery is affected in >70% of cases
• The compression may be dynamic
• The occlusion results in vertebrobasilar insufficiency
• It may be bilateral

References

1. 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. Interv Neurol 2016; 5:29-38. 
2. Zaidi HA, Albuquerque FC, Chowdhry SA, Zabramski JM, Ducruet AF, Spetzler RF. Diagnosis and management of bow hunter's syndrome: 15-year experience at barrow neurological institute. World Neurosurg 2014; 82:733-738. 
3. Huang S, Duan Q, Liang C, Yin D. A juvenile case of bow hunter's syndrome due to a bone fragment from an osteophyte of the atlas. Acta Neurol Belg 2023 (Online ahead of print).
4. Sakai S, Kasuya M, Kobayashi Y, Nonaka K, Suzuki M, Machida A. Bilateral bow-hunter's stroke caused by sleeping in prone position: A case of recurrent posterior circulation infarction. J Stroke Cerebrovasc Dis 2024; 33:108075.
5. Hong X, D'heygere E, Prisman E. Thyroid cartilage compression causing Bow Hunter's syndrome. Ann Otol Rhinol Laryngol 2023; 132:105-109. 
6. And 10 more. Subscribe to see the full list

Related checklists

• Posterior circulation stroke: causes
• Posterior circulation stroke: clinical features
• Posterior circulation stroke: lateral medullary syndrome
• Posterior circulation stroke: oculomotor nerve syndromes
• Posterior circulation stroke: hypoglossal nerve syndromes
• Posterior circulation stroke: other clinical syndromes
• Posterior circulation stroke: treatment