title: Bow hunter's syndrome causing vertebrobasilar insufficiency in a young man with neck muscle hypertrophy.
abstract: Vertebrobasilar insufficiency is characterized by impaired blood flow within the posterior circulation, producing symptoms of vertigo, nausea, vomiting, visual disturbances, and syncope. Given these nonspecific symptoms, the diagnosis of vertebrobasilar ischemia may be difficult to distinguish from more benign conditions. A healthy 37-year-old man presented to our clinic with near syncope upon turning his head to the left. Dynamic angiography revealed occlusion of the left vertebral artery at C7 with 90° head rotation to the left, consistent with bow hunter's syndrome. No obvious bony abnormalities were identified on computed tomography or magnetic resonance imaging scans. Transient rotational vertebral artery syndrome, a rare cause of vertebrobasilar insufficiency, has most often been reported at the C1-2 level, and the majority of cases occur in patients >50 years of age because of degenerative osteophytes and contralateral atherosclerosis. We present the unusual case of a young man with symptoms of vertebrobasilar insufficiency and discuss the potential effects of weightlifting and neck muscle hypertrophy on vertebral artery flow dynamics.
authors.affiliation: Department of Surgery, Tripler Army Medical Center, Honolulu, HI. Electronic address: joy.sarkar07@gmail.com.
authors.forename: Joy
authors.initials: J
authors.lastname: Sarkar
authors.affiliation: Department of Surgery, Tripler Army Medical Center, Honolulu, HI.
authors.forename: Stacey Q
authors.initials: SQ
authors.lastname: Wolfe
authors.affiliation: Department of Radiology, Tripler Army Medical Center, Honolulu, HI.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Ching
authors.affiliation: Department of Surgery, Tripler Army Medical Center, Honolulu, HI.
authors.forename: Dwight C
authors.initials: DC
authors.lastname: Kellicut
mesh_terms: D000328:Adult; D019416:Head Movements; D006801:Humans; D006984:Hypertrophy; D008297:Male; D009334:Neck Muscles / Q000473:pathology*; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012307:Risk Factors; D012399:Rotation; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014891:Weight Lifting