title: Moving target: transient rotational stenosis precipitating jugular bow hunter's syndrome.
abstract: A 60-year-old man presented with a 10-month history of of stereotypical spells characterized by vertigo, tinnitus, blurred vision, left hemibody numbness, and occasional syncope, precipitated by turning his head leftwards. Cerebral angiography and CT angiography of the head and neck with provocative maneuvers did not demonstrate vertebral artery narrowing. However, there was narrowing of the left internal jugular vein due to extrinsic compression from the sternocleidomastoid with leftward head rotation in the setting of hypoplasia of the right internal jugular vein. The patient underwent a cervical venogram which confirmed the finding. Manometric evaluation demonstrated a gradient of 29 mm Hg across the stenosis with the head turned leftwards compared with 1 mm Hg in the neutral position. The patient was treated with myectomies of the left sternocleidomastoid, posterior belly of the digastric, stylohyoid and omohyoid and styloid process removal. Following surgery, the patient reported complete resolution of symptoms. Repeat venography demonstrated resolution of the stenosis and pressure gradient.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Graffeo
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Avital
authors.initials: A
authors.lastname: Perry
authors.affiliation: Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: Zimmerman
authors.affiliation: Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Janus
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Pearce P
authors.initials: PP
authors.lastname: Morris
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Cascino
authors.affiliation: Rochester, Minnesota, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
mesh_terms: D002533:Cerebral Angiography; D000072226:Computed Tomography Angiography; D019416:Head Movements; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012399:Rotation / Q000009:adverse effects*; D013577:Syndrome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: Blood Flow; Cervical; Intracranial Pressure; Vein