Article ID: 10938
Here, we report the case of a 43-year-old man who presented with transient right visual field loss and numbness and weakness in the right upper and lower limbs in a few days after noticing posterior neck pain while playing golf. Though brain magnetic resonance imaging showed an acute cerebral infarction near the left lateral ventricle, there were no abnormalities identified on brain magnetic resonance angiography. Antithrombotic therapy was initiated; however, 1 week later, the posterior cerebral artery showed segmental stenosis and repeated cerebral infarctions occurred in only the posterior circulation territory over a period of 2 weeks. After lomerizine administration as a treatment for vasoconstriction, the stenosis improved without recurrence. A carotid artery echocardiography revealed markedly decreased blood flow in the right vertebral artery by mechanical stretch, with the probe in a flexed position after leftward rotation, which generally suggested bow hunter’s syndrome. However, the known pathogenetic mechanisms of bow hunter’s syndrome could not explain the present case. Therefore, we presumed that reversible cerebral vasoconstriction syndrome triggered by mechanical stress on the vertebral artery after neck rotation.
