Refractory Syncope with Head Rotation Leading to the Diagnosis of Bowhunter’s Syndrome Requiring Intensive Rehabilitation: A Case Report

Abstract

This is a case report regarding the presentation of Bowhunter’s syndrome, also known as vertebral artery rotational occlusion, leading to surgical intervention and intensive rehabilitation [1]. A 74-year-old man presented with syncope and vertigo with symptom onset after head rotation and CT angiogram showing cervical spondylosis and lateral mass hypertrophy causing significant compression of the right vertebral artery at C4-C5. A diagnostic cerebral angiogram then showed vertebral artery compression in the C4-C5 transverse foramen by lateral mass hypertrophy with lateral rotation of the head to the right. There was resolution of stenosis with the head in neutral or rotated to the left. The patient underwent a right C4-5 facetectomy with C3-6 fusion for Bowhunter’s Syndrome. After neurosurgical intervention, the patient had significant reduction in his symptoms, but with significant functional deficits. Bowhunter’s Syndrome is a rare cause of syncope that must be evaluated due to risk of ischemia to the posterior circulation. Intensive rehabilitation should be considered for patients that present with significant deficits due to prolonged ischemia leading to impaired activities of daily living and mobility after neurosurgical decompression.