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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(03): 572-575
DOI: 10.1055/s-0044-1787865
Case Report

Bow Hunter's Syndrome with Rotational Atlantoaxial Instability: A Rare Association

Malini S. 
1   Department of Neurosurgery, Indo American Hospital, Institute of Brain and Spine, Vaikom, Kerala, India
,
Anu C. Thomas
1   Department of Neurosurgery, Indo American Hospital, Institute of Brain and Spine, Vaikom, Kerala, India
,
Sajeev S. Vadakkedam
1   Department of Neurosurgery, Indo American Hospital, Institute of Brain and Spine, Vaikom, Kerala, India
,
Parameswaran K.
2   Department of Neurology, Indo American Hospital, Institute of Brain and Spine, Vaikom, Kerala, India
,
Anand M.
3   Department of Interventional Neuroradiology, Indo American Hospital, Institute of Brain and Spine, Vaikom, Kerala, India
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Abstract

Bow Hunter's syndrome (BHS) is a very rare condition in which there is rotational vertebral artery (VA) insufficiency. The association of BHS with rotational atlantoaxial instability is extremely rare. We are reporting a case of pediatric BHS who presented with features of VA insufficiency on neck rotation. Careful evaluation revealed rotational C1-C2 instability. Provocative digital subtraction angiography and dynamic neck computed tomography were the mainstay of our diagnostic armamentarium. Our case emphasizes the fact that VA abnormalities need special consideration in young patients with craniovertebral junction instability and a high degree of suspicion is necessary in most instances for accurate diagnosis.

Keywords

Bow Hunter's syndrome - atlantoaxial rotatory subluxation - C1-C2 fusion

Note

Bow Hunter's syndrome is a disorder resulting in rotational vertebral artery insufficiency. It is a rare but dangerous entity that in some cases may cause profound neurological deficits and may turn fatal if not recognized and treated promptly.




Publication History

Article published online:
25 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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