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Rare cause of Bow Hunter’s syndrome due to an aberrant course of a vertebral artery
  1. Kaishin Tanaka1 and
  2. Brendan Steinfort2
  1. 1 Interventional Neuroradiology, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
  2. 2 Neurosurgery, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
  1. Correspondence to Brendan Steinfort, bsteinfort{at}


Bow Hunter’s syndrome (BHS) is a rare cause of vertebrobasilar insufficiency and is reported to most commonly be caused by vertebral artery impingement on cervical vertebrae osteophytes. We report a case in a 56-year-old male patient who on investigation of recurrent posterior circulation ischaemic strokes was found to have BHS. The aetiology of the syndrome in this patient is due to a particularly unusual aberrancy in the path of the atlantoaxial portion of the culprit left vertebral artery. Aberrancy of the distal portion of the vertebral artery is in itself a rare entity, and there are few reports of it in relation to BHS. The patient in this case was successfully treated with endovascular sacrifice of the vertebral artery with no further dynamic occlusive symptoms.

  • neuroimaging
  • stroke
  • neurology
  • interventional radiology
  • neurosurgery
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  • Contributors BS, the corresponding author, conceived the idea for the case report and advised on the content of the report. The patient reported upon was known to BS and was treated by BS. KT, the first author, performed literature reviews and collated references. KT obtained further information from the patient required for the case report, obtained consent from the patient and wrote the manuscript. BS performed the angiograms on the patient and obtained the imaging to be included in the case report, interpreted the imaging and BS edited the manuscript and provided overall supervision to KT.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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