Zespół łucznika (zespół rotacyjnej niedrożności tętnicy kręgowej). Rotational vertebral artery occlusion (‘‘bow hunter syndrome’‘). The authors declare no conflict of interest. unique symptoms from PICA were caused by unusual compression of the non-dominant VA at the level of the entrance in the inter-transversal canal. In the case reported by Di Stefano et al. It is also very important to highlight that anatomical variants can result in atypical BHS. BHS secondary to pseudoaneurysm of V3 segment with contralateral VA hypoplasia and a spasm of VA with an aneurysm in its further course were also described. In yet another publication, the described subject developed BHS due to a compression of persistent first intersegmental artery, a rare variant of VA, under an incomplete arch of C1 vertebrae. An arterial embolic aetiology was demonstrated in one study. One publication illustrated an atherosclerotic stenosis of VA combined with spondylosis responsible for VAO. Dissection of VA was reported to be the cause of BHS in another case.
There was also a case of BHS caused by tortuosity of L-VA in V1 segment with contralateral VA hypoplasia. Only a few cases of patients with isolated VA hypoplasia as the leading cause of BHS have been published. It was reported only in 11 cases, which equals 5% of the documented BHS patients. Among possible pathomechanisms of BHS, vascular pathology is regarded as one of the least frequent. The most common anatomic location of VA occlusion is at C3-C7 vertebrae level, as it was also detected in our patient. The majority (52%) of BHS cases are driven by pathologies located below C2 vertebrae. Management of BHS includes conservative treatment or interventional approaches-open surgery or endovascular procedure. Therefore dynamic USGD with the following D-CTA are recommended as less invasive tools in determining the diagnosis of BHS. No abnormalities of other cerebral arteries were observed.ĭigital Dynamic Subtraction Angiography (DDSA) remains the gold standard in the diagnostic process, however this invasive method requires the application of extensive radiation and restriction of patient’s position during the examination. It was also observed that basilar artery (BA) was formed exclusively by L-VA.
3D reconstructions of this pathology were also obtained ( Figure 3A,B). In this examination the lumen of L-VA was narrowed up to 2 × 3.2 mm, causing 60% stenosis according to the NASCET criteria ( Figure 2B). Subsequently, D-CTA was acquired during left-side rotation of the head. There was no L-VA stenosis in this position ( Figure 2A). L-VA had a tortuous course and it formed a loop at the level of the C4 vertebrae. Furthermore, hypoplasia of R-VA was demonstrated (widths: R-VA 1.9 mm L-VA 3.6 mm). It revealed atheromatous plaques in both carotid bulbs (slightly calcified maximum thickness: 2.8 mm) with no hemodynamically significant stenosis, grade 2 of kinking of R-ICA and a tortuosity of L-ICA. Firstly, the imaging was conducted with the patient’s head in the neutral position. The consequences of VAO may be life-threatening, therefore it is important to remind physicians about this syndrome, its clinical presentation and diagnostic algorithm.īecause of the suspected dynamic stenosis, a dynamic CT angiography (D-CTA) of the carotid, vertebral and cerebral arteries was performed. Due to non-specific symptoms, patients with BHS are usually misdiagnosed in daily clinical practice.
Moreover, recently, an interesting case of BHS due to compression of non-dominant vertebral artery with recurrent posterior inferior cerebellar artery (PICA) syndrome was described. Vertebrobasilar insufficiency in BHS patients causes different clinical manifestations such as: syncope, vertigo or dizziness, nausea and/or vomiting, balance, gait and/or coordination disturbances, dysarthria, motor or sensory deficits, visual impairment and diplopia. The most common aetiologies of BHS are atherosclerosis, thromboembolism, trauma, tumors, osteophytes, fibrous bands, chiropractic manipulation, surgery, sports accidents, atlantoaxial instability, intervertebral disc herniation, congenital anomalies of vertebrae, neck muscles hypertrophy and vascular malformation. Bow Hunter’s syndrome (BHS), also known as rotational vertebral artery occlusion (VAO), is a rare condition in which vertebral artery is reversibly compressed due to rotation or extension of the head.
0 kommentar(er)
