• Images in Neurosurgery

    • Sep 26, 2017

    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.

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