Bow hunter's syndrome (BHS) is a clinical condition caused by circulatory insufficiency in the vertebral basilar artery region during head rotation. We report a case of BHS diagnosed after treatment for vestibular neuritis.
A 79-year-old woman visited our hospital complaining of vertigo upon head rotation to the left. Examination revealed right horizontal nystagmus in the supine position, additional torsional nystagmus in the lower right head position. Initially, left acute peripheral vestibular syndrome was suspected, and the patient received conservative treatment, including vestibular rehabilitation, but the dizziness associated with the cervical torsion persisted even after a month. Duplex ultrasound revealed severe stenosis of the right vertebral artery during head rotation to the right, indicating circulatory insufficiency in the vertebral artery region as the cause of the dizziness. Vertebral angiography revealed significant meandering of the right vertebral artery at C3/C4 and occlusion during right cervical hyper-rotation. Therefore, the patient was diagnosed as having BHS and treated with antiplatelet drugs and provided lifestyle guidance to prevent rightward cervical hyper-torsion. Thereafter, the patient remained asymptomatic for at least 1 year.
BHS is a rare condition and can be confused with peripheral dizziness when accompanied by vestibular disorder. In cases presenting with dizziness during head rotation, we believe that BHS should be included in the differential diagnosis.
