title: Rare Etiology of Bow Hunter's Syndrome and Systematic Review of Literature.
abstract: BACKGROUND
  Bow Hunter's Syndrome is a mechanical occlusion of the vertebral artery which leads to a reduction in blood flow in posterior cerebral circulation resulting in transient reversible symptomatic vertebrobasilar insufficiency.
  
  
  METHODS
  We present a case of Bow Hunter's syndrome in a 53-year-old male that occurred after the patient underwent surgical correction of a proximal left subclavian artery aneurysm. Shortly after the surgery, the patient began to complain of transient visual changes, presyncopal spells, and dizziness upon turning his head to the left. A transcranial doppler ultrasound confirmed the diagnosis of Bow Hunter's syndrome.
  We analyzed the data on 153 patients with Bow Hunter's syndrome from the literature. An osteophyte was the most common cause of vertebral artery occlusion, and left vertebral artery was more commonly involved in patients with Bow Hunter's syndrome. Dynamic angiography was the definitive imaging modality to confirm the diagnosis, and surgery was most successful in alleviating symptoms.
  
  
  CONCLUSIONS
  We believe that this is the first case of iatrogenic Bow Hunter's syndrome after surgical intervention for an aneurysm repair, and the largest review of literature of Bow Hunter's syndrome. Dynamic angiography is the gold standard for the diagnosis of Bow Hunter's syndrome. Surgery should be considered as the primary treatment approach in these patients, especially those who have bony compression as the etiology.
authors: Department of Neurology, University of Florida College of Medicine, Gainesville, FL-32611, USA.
authors: Vaibhav
authors: V
authors: Rastogi
authors: Department of Neurology, University of Florida College of Medicine, Gainesville, FL-32611, USA.
authors: Ashley
authors: A
authors: Rawls
authors: Department of Neurology, University of Florida College of Medicine, Gainesville, FL-32611, USA.
authors: Omar
authors: O
authors: Moore
authors: Department of Neurology, University of Florida College of Medicine, Gainesville, FL-32611, USA.
authors: Benjamin
authors: B
authors: Victorica
authors: Department of Neurology, University of Florida College of Medicine, Gainesville, FL-32611, USA.
authors: Sheema
authors: S
authors: Khan
authors: Department of Neurology, University of Florida College of Medicine, Gainesville, FL-32611, USA.
authors: Pradeepan
authors: P
authors: Saravanapavan
authors: Department of Neurology, University of Florida College of Medicine, Gainesville, FL-32611, USA.
authors: Sunitha
authors: S
authors: Midivelli
authors: Department of Internal Medicine, St. Mary's Medical center, Duluth, MN-55805, USA.
authors: Prathap
authors: P
authors: Raviraj
authors: Department of Neurology, University of Florida College of Medicine, Gainesville, FL-32611, USA.
authors: Anna
authors: A
authors: Khanna
authors: Department of Radiology, University of Florida College of Medicine, Gainesville, FL-32611, USA.
authors: Sharathchandra
authors: S
authors: Bidari
authors: Department of Neurology, University of Florida College of Medicine, Gainesville, FL-32611, USA.
authors: Vishnumurthy S
authors: VS
authors: Hedna
keywords: Bow Hunter’s syndrome; dynamic angiography; iatrogenic; rotational vertebrobasilar insufficiency; surgery