Bow Hunter’s syndrome is a rare neurological disorder that can cause dizziness, fainting, and other symptoms. It can resolve itself naturally, but it’s treatable if a doctor diagnoses and treats it properly.

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Bow Hunter’s syndrome is a condition whose symptoms people can easily miss, but it can lead to significant impairment. It is a rare condition that occurs due to anatomic abnormalities, and it is treatable.

Read on to find out more about this syndrome, why it happens, and how doctors treat it.

Bow Hunter’s syndrome, also known as rotational vertebral artery syndrome, is a rare condition.

This syndrome causes compression of or injury to the vertebral artery when you rotate your head and neck. This results in symptoms like fainting, dizziness, and tinnitus, to name a few. The symptoms usually resolve when the head is back in a neutral position.

Experts named the syndrome based on the position of the head when a person shoots an arrow.

The condition is most common in people 50 to 79 years old. It also occurs more often in males than females, at about a 2-to-1 ratio. Doctors diagnose it in a handful of children every year, and it is rare in that population.

The underlying cause is usually a bone spur that can block the blood flow or cause injury to the blood vessel wall, which can result in a thromboembolism, or blood clot. Other causes can include:

Bow Hunter’s syndrome may occur more frequently in older adults. Also, some risk factors associated with the syndrome include:

In adults, the presentation can vary, but common symptoms can include:

People may also report or show symptoms of repeated transient ischemic attacks, commonly called ministrokes.

The syndrome can be hard to diagnose because these symptoms are also symptoms of disorders of the vestibular system, or the sensory system in your head and neck.

In the few children with this syndrome, doctors only detect the syndrome when a child has a tear in the vertebral artery, causing blood clots that cause a stroke. Even after it heals, there is a weak spot that remains in the artery, which is vulnerable to tearing again and causing more strokes.

Over time, repeated transient ischemic attacks or vestibular strokes can cause long-term brain deficits, dizziness, fainting, and impaired balance. This can lead to falls and injuries.

People who show symptoms of Bow Hunter’s syndrome may want to consider contacting a neurologist for a thorough examination and diagnosis.

If a doctor suspects Bow Hunter’s syndrome, they can perform an MRI, a magnetic resonance angiography, or a computed tomography angiography. The tests can help find atypical bony areas, infarction lesions, and vertebral artery narrowing. They can also take your medical and family history, a history of the presenting condition, and give you a physical exam.

To confirm Bow Hunter’s syndrome, a digital subtraction angiography will show the arteries as usual when the head is in a neutral position, and upon head rotation, it will show stenotic arteries or vascular blockage.

Other tests that a doctor may perform before and after surgery can include:

Because Bow Hunter’s syndrome is such a rare disorder, doctors still need to standardize the treatment and management of it.

Treatment is often surgical, but there are more conservative treatment options as well. These may include neck immobilization with a neck brace or cervical collar.

Doctors usually advise people with Bow Hunter’s syndrome not to turn their heads in the problematic directions. To help prevent strokes, doctors typically give people antiplatelet and anticoagulation medications.

If conservative therapy does not improve symptoms, surgery may be necessary. It can also be curative for Bow Hunter’s syndrome. Procedures doctors use include:

  • surgical decompression of the vertebral artery
  • corrective fusion of C1 and C2 vertebrae
  • endovascular stenting of the vertebral artery
  • coil embolization of the symptomatic nondominant vertebral artery

Doctors often personalize treatment for each person, depending on the underlying cause of the vascular compression or injury.

In children with Bow Hunter’s syndrome, fusing the top two vertebrae of the neck can help prevent repeat strokes. While there are risks like spinal cord injury, atypical spine growth, and the need for revision surgery, doctors can prevent recurrent strokes that cause significant neurological damage.

Consider talking with your child’s surgeon about the risks and benefits of surgical treatment for Bow Hunter’s syndrome.

Bow Hunter’s syndrome is a highly treatable condition if doctors diagnose it properly.

There have been conflicting studies about conservative management of Bow Hunter’s syndrome in adults.

Some studies show that symptoms resolve with conservative treatments.

Other studies show that people go on to experience strokes. This is why doctors try to personalize people’s treatments to their specific symptoms, response to treatment, and underlying causes of Bow Hunter’s syndrome.

It’s important to keep in mind that surgical treatment, including endovascular procedures, can heal the underlying causes of the condition.

In children, Bow Hunter’s syndrome tends to be much more serious, and with conservative treatment, the vertebral artery often tears post-treatment, causing recurrent strokes. This can cause significant brain injury. Surgical treatment with a fusion of the top two vertebrae can often be more effective at preventing recurrent strokes.

Bow Hunter’s syndrome, also known as rotational vertebral artery syndrome, is a rare but treatable condition that causes neurological symptoms and may cause strokes when a person rotates their head.

While it most often occurs in males from 50 to 70 years old, it can occur in females and, even more rarely, in children. When it does occur in children, it is often more serious, resulting in recurrent strokes. The condition may be manageable and curable with the appropriate diagnosis and treatment.