• Daniel R Felbaum, Joshua E Ryan, Andrew B Stemer, and Amjad N Anaizi.
• Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, DC, USA.
• World Neurosurg. 2017 Jan 1; 97: 762.e5-762.e10.

BackgroundRotational vertebral artery occlusion, or bow hunter's syndrome, most commonly affects the C1-2 level because of its importance in regulating rotational movement.Case DescriptionA 50-year-old man with increasing neck pain and severe symptoms of vertebrobasilar insufficiency with bidirectional head rotation had undergone several prior subaxial cervical spine operations. Dynamic cerebral angiography demonstrated complete occlusion of the left vertebral artery during head rotation to the right and complete occlusion of the right vertebral artery during head rotation to the left. Occlusions occurred at the level of and rostral to his prior construct, with immediate recurrence of debilitating vertigo and near syncope. Successful radiographic and clinical resolution of symptoms was achieved by posterior instrumentation and fusion from C2, connecting to his prior hardware.ConclusionsA brief literature review and treatment options are discussed for this unusual presentation of a rare clinical entity.Copyright © 2016 Elsevier Inc. All rights reserved.

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