Diagnosis of Bilateral Bow Hunter’s Syndrome in an Adolescent Using Dynamic Cervical Magnetic Resonance Angiography: A Case Report.

BACKGROUND: Bow hunter's syndrome (BHS), also known as rotational vertebral artery occlusion syndrome, is a hemodynamic disorder caused by mechanical compression of the vertebral artery during head rotation or hyperextension. This compression may lead to transient occlusion or significant stenosis, resulting in posterior circulation ischemia. BHS is relatively rare in clinical settings, and most reported cases occur in middle-aged or elderly patients. Its etiology is commonly associated with degenerative cervical conditions, such as osteophyte formation or disc herniation. In addition, the condition most often involves unilateral vertebral artery compromise.

CASE PRESENTATION: In this study, we report a rare case of BHS in a 15-year-old adolescent without noticeable cervical degenerative changes who experienced recurrent, unexplained posterior circulation cerebral infarctions. Dynamic cervical magnetic resonance angiography (MRA) revealed significant compression of both vertebral arteries during head and neck rotation, confirming a diagnosis of bilateral BHS. This presentation differs from the conventional understanding that BHS predominantly affects adults and is typically unilateral, suggesting that the diagnosis should also be considered in young patients, even in the absence of typical cervical lesions.

CONCLUSION: This study is the first report identifying bilateral BHS as the cause of recurrent posterior circulation infarction in a teenager using dynamic MRA. Although dynamic digital subtraction angiography remains the gold standard for diagnosis, this case highlights the practical value of dynamic MRA in diagnosing BHS.