Donald D. Davis
Last Update: January 2, 2021.
Continuing Education Activity
Rotational vertebral artery syndrome, or “Bow Hunter syndrome,” is a very rare diagnosis that is easily missed. Furthermore, symptoms are very nonspecific and caused by underlying anatomic abnormalities or derangements. This activity serves to examine the underlying pathology of this rare cause of vertebrobasilar insufficiency and aid practitioners in prompt and accurate diagnosis.
Objectives:
Review the relevant anatomy associated with rotational vertebral artery syndrome.
Outline the pathogenesis of rotational vertebral artery syndrome.
Explain the difficulty in the diagnosis of rotational vertebral artery syndrome as the underlying cause of vertebrobasilar insufficiency.
Summarize the importance of an interdisciplinary approach to diagnosing and treating rotational vertebral artery syndrome.
Introduction
Rotational vertebral artery syndrome, or colloquially “bow hunter syndrome,” is a rare cause of vertebrobasilar insufficiency. In patients with Bow Hunter Syndrome, rotation of the head and neck can lead to compression of the vertebral artery at the atlantoaxial or subaxial levels in the spine. The name “bow hunter syndrome” is derived from a patient who developed Wallenberg syndrome (a lateral medullary infarction) during archery practice due to poor circulation with his head turned for extended periods.[1]
Understanding the anatomy of the vertebral artery is critical to the pathogenesis of bow hunter syndrome. The vertebral arteries originate from the subclavian arteries. They generally enter deep into the transverse process of C6 in most cases (C7 in 7.5% of cases) and ascend through the transverse foramen of each cervical vertebrae. After ascending through the transverse foramen of the atlas (C1), the vertebral arteries travel along the posterior arch of C1 and into the suboccipital triangle where they enter the foramen magnum.[2]….