Key result
Positional Doppler ultrasound identifies vertebral artery occlusion in Bow Hunter syndrome, guiding successful long-term management.
Why the study?
Bow Hunter syndrome results from dynamic vertebral artery stenosis or occlusion during neck rotation, and this case report examines positional cervical Doppler ultrasonography suggesting proximal vertebral artery obstruction.
Case Report (n=1)
No
Positional cervical Doppler waveform analysis showing a transient to-and-fro pattern followed by a delayed systolic peak can noninvasively localize dynamic proximal vertebral artery obstruction in Bow Hunter syndrome and guide targeted anatomical imaging.
Answers are grounded in this paper and cite their sources.
Positional Doppler may support noninvasive detection of dynamic vertebral obstruction; leaves open its accuracy versus angiography before wider use.
Background Bow Hunter syndrome results from dynamic vertebral artery stenosis or occlusion during neck rotation. Case presentation: A man in his 70s presented with dizziness, nausea, and vomiting and was diagnosed with left occipital and right cerebellar infarctions. On hospital day 7, rightward neck rotation reproduced the dizziness. Positional cervical Doppler ultrasonography showed normal antegrade flow in the left vertebral artery in the neutral position, a to-and-fro waveform immediately after rotation, and partial recovery after approximately 30 s with a delayed systolic peak. These findings suggested an intermittent obstruction proximal to the sampling site. Computed tomography angiography in the neutral and rightward-rotated positions demonstrated kinking and slit-like narrowing of the proximal left vertebral artery at T1. Rotational digital subtraction angiography confirmed marked flow reduction. Computed tomography angiography revealed no fixed extravascular compressive lesions. The patient was treated with aspirin and restriction of neck rotation. Conclusions Positional Doppler waveform analysis may help guide the selection of anatomical imaging, although angiographic confirmation remains necessary.
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Uchida et al. (2026) conducted a case report in Bow Hunter syndrome with acute posterior circulation infarction (left occipital lobe and right cerebellar hemisphere) (n=1). Positional cervical Doppler ultrasonography and conservative management (aspirin and cervical collar restriction of neck rotation) was evaluated on Hemodynamic localization of vertebral artery obstruction and symptom recurrence. Positional cervical Doppler ultrasonography identified proximal left vertebral artery obstruction at T1 in a 73-year-old man with Bow Hunter syndrome, who remained symptom-free for 1 year.
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