Abstract Details

Title Dynamic Vertebral Artery Compression-hemodynamic Confirmation of Bow Hunter’s Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 5-009

Objective

To describe a rare case of posterior circulation stroke secondary to dynamic vertebral artery compression following cervical trauma, emphasizing diagnostic and management considerations.

Background Cerebellar infarction is most often related to embolic or atherosclerotic vertebrobasilar disease. Rarely, dynamic vertebral artery (VA) compression produces flow-limiting posterior circulation ischemia, classically described as Bow Hunter’s syndrome. Recognition is crucial because the underlying mechanism is surgically correctable, differing fundamentally from standard antithrombotic strategies.

Design/Methods

Single-patient case report detailing clinical presentation, neurological examination, and multimodal vascular imaging including CT, CTA, and dynamic digital subtraction angiography.

Results A 72-year-old woman with hypertension and a recent odontoid fracture presented with acute nausea, vomiting, and truncal ataxia. CT demonstrated a right cerebellar infarct, while CTA suggested high-grade narrowing of right V3 section of vertebral artery. Digital subtraction angiography with provocative maneuvers showed dynamic compression: extension of the neck produced near-occlusion of the dominant right VA, with immediate flow restoration in neutral flexion establishing a diagnosis of positional vertebrobasilar insufficiency. The patient was treated with antiplatelet therapy, statin, and rigid cervical immobilization, with neurosurgery deferring occipitocervical fusion until the post-acute phase. This case illustrates how dynamic vascular mechanics can drive posterior circulation infarction. Conventional static CTA or MRA often underestimates the pathology; catheter-based angiography with head positioning remains the diagnostic gold standard .From a therapeutic perspective, conservative management carries a high recurrence risk, whereas surgical stabilization offers durable protection, underscoring the need for neurointerventionalists to assess real-time hemodynamic changes rather than static vessel caliber.

Conclusions Dynamic vertebral artery compression should be considered in posterior circulation ischemia, particularly in the context of cervical trauma or instability. Prompt angiographic evaluation with provocative maneuvers is essential to identify this surgically addressable mechanism of stroke.

Authors/Disclosures
Madhu Jatty, MBBS PRESENTER	Dr. Jatty has nothing to disclose.
Kanmani Muthiah, MBBS	Dr. Muthiah has nothing to disclose.
Cheran Elangovan, MD (University of Tennessee Health Science Center)	Dr. Elangovan has nothing to disclose.

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