Dr Sharath Kumar G

🧠 When turning the head causes a stroke… think beyond the brain. A fascinating case of Bow Hunter Syndrome (rotational vertebral artery occlusion): 🔹 Recurrent posterior circulation strokes 🔹 Occipitalization of C1 🔹 C1–C2 bony anomaly with an osteophyte at the C2 transverse foramen 🔹 Routine static angiography was inconclusive 🔹 Dynamic cerebral angiography clinched the diagnosis 🎯 The patient was asked to turn the head to the LEFT. Injection of the right occipital artery demonstrated dynamic compression of the vertebral artery at the C2 transverse foramen. The key lesson: The culprit may only appear when the head moves. In patients with recurrent posterior circulation ischemia + reproducible neck pain/neurological symptoms with rotation, dynamic vascular imaging can be diagnostic—and potentially stroke-preventing. #BowHunterSyndrome #VertebralArtery #Stroke #Neurointervention #Neuroradiology #DynamicDSA #PosteriorCirculationStroke

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