• Images in Neurosurgery

    Authors: Todd Hollon
    D. Andrew Wilkinson

    An 11-year-old boy presents with multiple intermittent episodes of right-sided tongue numbness, left hemiparesis, and paresthesias. Workup for vertebral artery dissection was inconclusive; aspirin was initiated for antiplatelet therapy. Patient suffered an additional episode of visual disturbances and extreme lethargy, subsequently returning to baseline. A second formal diagnostic angiogram was completed that included dynamic head turning, revealing complete occlusion of the right vertebral artery with head turning to the left. C1-2 fusion was completed to limit motion and intermittent occlusion. Patient has been asymptomatic postoperatively.

    Figure 1: CT angiogram reconstruction of the right vertebral artery shows normal vasculature without evidence of dissection or stenosis.

    Figure 2: Time-of-flight MR angiogram demonstrates appropriate flow through right vertebral artery.

    Figure 3: With head in neutral position, digital subtraction angiogram shows patent right vertebral artery.

    Figure 4: Head turning to the left causes complete occlusion of the right vertebral artery consistent with Bowhunter's syndrome.

    Figure 5: With head returned to neutral position, right vertebral artery recanalizes with good distal flow.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site here. Privacy Policy