title: Recurrent juvenile ischemic stroke caused by bow hunter's stroke revealed by carotid duplex ultrasonography.
abstract: Bow hunter's stroke (BHS) is a rare cause of vertebrobasilar insufficiency due to rotational vertebral artery (VA) occlusion associated with head turning. We report a juvenile patient presenting with recurrent ischemic stroke caused by BHS, which was revealed by carotid duplex ultrasonography. Carotid duplex ultrasonography performed in the neutral position showed normal findings. However, disappearance of end-diastolic blood flow of contralateral VAs was observed with head rotation. Digital subtraction angiography confirmed occlusion at C1/2 levels in the VA contralateral to the head rotation, bilaterally. Importantly, our patient did not recognize the association of head rotation and previous episodes of stroke. We suggest that BHS should be considered in patients with cryptogenic stroke occurring in the vertebrobasilar artery territory.
authors.affiliation: Stroke Division, Department of Neurology, Dokkyo Medical University, Tochigi, Japan.|Center of Medical Ultrasonics, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Takekawa
authors.affiliation: Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. keisuke@dokkyomed.ac.jp.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Stroke Division, Department of Neurology, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Takahito
authors.initials: T
authors.lastname: Nishihira
authors.affiliation: Stroke Division, Department of Neurology, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Iwasaki
authors.affiliation: Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
authors.forename: Eisei
authors.initials: E
authors.lastname: Hoshiyama
authors.affiliation: Stroke Division, Department of Neurology, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Madoka
authors.initials: M
authors.lastname: Okamura
authors.affiliation: Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
authors.forename: Ayaka
authors.initials: A
authors.lastname: Numao
authors.affiliation: Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
authors.forename: Shiho
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D012008:Recurrence; D012399:Rotation; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology; D018084:Ultrasonography, Interventional; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Bow hunter’s stroke; Carotid duplex ultrasonography; Juvenile ischemic stroke