A Subtype of Bow Hunter’s Syndrome Requiring Specific Method for Detection: A Case of Recurrent Posterior Circulation Embolism due to “Hidden Bow Hunter’s Syndrome”

抄録

Objective: A condition that presents with recurrent embolism due to “hidden bow hunter’s syndrome,” a subtype of bow hunter’s syndrome with a different pathogenic mechanism, is reported.

Case Presentation: The patient was a 78-year-old male who exhibited recurrent embolic stroke of the posterior circulation territory resistant to medical treatment. DSA showed occlusion of the right vertebral artery (VA), but dynamic left vertebral arteriography (VAG) presented no change in blood flow. Since indirect signs of occlusion and recanalization of the right VA were retrospectively obtained, dynamic right VAG was performed again on another day, which revealed that the occluded right VA in the neutral neck position recanalized when the neck was rotated to the left. Suspecting that thrombi formed during occlusion scattered with recanalization, we performed embolization of the parent artery in the distal right VA for the prevention of recurrence.

Conclusion: This pathological condition should be considered as a differential diagnosis if unexplained ischemia of the posterior circulation is accompanied by unilateral VA occlusion.