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A 50-year-old man with a 10-year history of hypertension has been bothered by episodic dizziness induced by leftward head rotation for 7 years. Persistent dizziness and nausea lasting for over 24 hours brought him to the hospital the other day. Electronystagmogram indicated poor bilateral optokinetic nystagmus. Brain magnetic resonance image identified no irregularity, while magnetic resonance angiography showed left vertebral arterial hypoplasia. Transcranial color-coded Doppler scans showed that the blood flow velocities of basilar and right vertebral arteries were slowed down by leftward head rotation. He was diagnosed with vertebral arterial hypoplasia with Bow Hunter's syndrome (BHS) leading to impairment in bilateral pontine gaze centers, medial longitudinal fascicules and abducens nuclei. Oral antiplatelet was prescribed and lifestyle changes recommended to help prevent recurrence. Due to the fact that BHS is rarely seen in clinical settings, most frontline physicians are not familiar with it. Severe BHS could present with brainstem and cerebellar symptoms and may sometimes be misinterpreted as Ménière's disease. It is even more difficult to distinguish BHS from benign paroxysmal positional vertigo in the case of comorbidity.


DeKleyn A, Versteegh C: Uber verschiedene formen von nemieres syndrom. Deutsche Ztschr Nervenh 1933; 132: 157-89. [In German].
Zaidi, H. A.,Albuquerque, F. C.,Chowdhry, S. A.,Zabramski, J. M.,Ducruet, A. F.,Spetzler, R. F.(2014).Diagnosis and management of Bow Hunter's syndrome: 15-year experience at Barrow Neurological Institute.World Neurosurg.82,733-8.
Anene-Maidoh, T. I.,Vega, R. A.,Fautheree, G. L.,Reavey-Cantwell, J. F.(2013).An unusual case of pediatric bow hunter's stroke.Surg Neurol Int.4,148.


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