BOW HUNTER SYNDROME
1 The Department of Neurology, Faculty of Medicine, Sriwijaya University, Mohammad Hoesin General Hospital
Bow hunter’s syndrome (BHS) is a rotational vertebral artery syndrome, where all the symptoms and signs clinically presented are due to a sudden vertebral artery insufficiency following neck rotation. BHS more common occurs in males age between 50 to 70 years old. A 55 years old female was admitted to the RSMH complaining dizziness attacks if she turns her head to the right, usually accompanied by a sudden right visual loss.
All the symptoms are cleared out completely whenever she puts her head back straight again. She had been suffering from this annoying yet worrisome ailment for at least 8 years. Physical and neurological examinations as well as laboratory work-ups fail to show any abnormality. Digital substract angiography (DSA) showed signs of asymptomatic sclerotic in cervical segment of the right internal carotid artery area and a kinking of the left vertebral artery at the border of C2 and atlas. A significant decrease of basilary and posterior cerebral artery blood flow appeared when the patient turned her head laterally especially to the right. The DSA findings explained the temporary vertigo and the sudden right visual loss suffered by the patient. The patient was discharged from the hospital with a suggestion to turn her head wisely and takes some vertigo medication only whenever needed. An internal carotid stents is proposed in the future.