Vascular Ultrasound Measurements After Atlas Orthogonal Chiropractic Care
in a Patient With Bow Hunter Syndrome
J Chiropractic Medicine 2018 (Dec); 17 (4): 231236 ~ FULL TEXT
Bow hunter syndrome (BHS) is also known as bow hunter stroke and rotational vertebral artery syndrome. Bow hunter syndrome is a rare cause of vertebrobasilar insufficiency; the mechanism was first postulated in cadaveric studies of the early to mid20th century. [1, 2] Sorensen coined the term in 1978 based on the symptoms occurring with the activity of archery.  Bow hunter syndrome is most commonly a result of a mechanical compression of the vertebral artery (VA), except for rare cases where compression results from intrinsic vascular problems such as atherosclerosis.  The resultant occlusion or stenosis of the VA occurs with head rotation and typically in the dominant VA. Because the occlusion is dynamic, the symptoms are typically transient, dependent on head position. The most commonly reported symptoms are syncope, near-syncope, drop attack, vertigo, dizziness, and impaired vision. Other less commonly reported symptoms include dysarthria, dysphasia, diplopia, nystagmus, numbness, paresthesia, nausea, headache, neck pain, arm pain, tinnitus, and ataxia.  Transient vision loss (TVL) and blindness have also been reported in some cases. [4, 5, 79] Bow hunter syndrome studies are limited to case studies and case series. The largest overview of BHS to date was published by Jost and Daily  in 2015, in which 126 cases were described and categorized and in which a variety of causes, sites of stenosis, and treatment regimens are described. The condition can result in permanent neurologic deficit if left undiagnosed.