Bow hunter syndrome (BHS) is an uncommon cause of vertebrobasilar insufficiency that results from occlusion or injury to the vertebral artery (VA) during neck rotation. The cause is often a bony abnormality that may compress the VA compromising distal flow or lead to vessel wall injury resulting in thromboembolism.

 A 26-year-old female,6 month antenatal presented to our hospital with intermittent dizziness exacerbated by turning her head since one week . She acutely developed dysphagia, nasal regurgitation and alterd sensorium on the day of presentation to the emergency. There was no history of fever, rashes, headache, or neck trauma. There was no family history of similar complaints, vascular or connective tissue diseases, strokelike episodes, seizures, or early-onset dementia. Examination demonstrated impairment of consciousness, quadriparesis and palatal palsy.  Aspirin was initiated for secondary stroke prevention and the patient was monitored.