Bilateral bow-hunter's stroke caused by sleeping in prone position: A case of recurrent posterior circulation infarction

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-10-16 DOI:10.1016/j.jstrokecerebrovasdis.2024.108075

Sawako Sakai MD, Masatoshi Kasuya MD, Yuki Kobayashi MD, Kazuya Nonaka MD, Masashi Suzuki MD, Akira Machida MD, PhD

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引用次数: 0

Abstract

Objectives Bow hunter's stroke (BHS) is a condition characterized by temporary vertebrobasilar insufficiency caused by mechanical compression or occlusion of the vertebral artery when the head is rotated, leading to transient neurological symptoms such as dizziness, vertigo, nystagmus, dysarthria, and potentially stroke. Therefore, a situation in which the head remains rotated for an extended period is a significant risk factor for BHS.

Materials and Methods We present a case of a 25-year-old woman who experienced three recurrent cerebral infarctions in the posterior circulation area after sleeping in a prone position with her head rotated.

Results The first infarction occurred in the right thalamus, followed by bilateral cerebellar infarctions, and finally, an infarction in the left cerebellar hemisphere. Carotid Doppler ultrasonography revealed blood flow interruption in the left vertebral artery due to head rotation, and digital subtraction angiography showed that rotation of the head to one side resulted in blood flow disruption of the contralateral vertebral artery in both right and left rotation. A C1-2 posterior fixation surgery was performed to stabilize the atlas and axis using screws and rods, with no recurrence observed thereafter.

Conclusions When encountering a young patient with recurrent posterior circulation infarctions upon awakening, it is crucial to inquire about the patient's sleeping position, such as prone positioning, to assess for potential vertebral artery stenosis or occlusion due to head rotation.

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俯卧睡姿导致的双侧猎弓者中风：复发性后循环梗死病例。

目的：猎弓者中风（BHS）是指头部旋转时，椎动脉受到机械性压迫或闭塞而引起的暂时性椎基底动脉供血不足，从而导致头晕、眩晕、眼球震颤、构音障碍等一过性神经症状，并可能导致中风。因此，头部长时间旋转是导致脑卒中的重要危险因素：我们介绍了一例 25 岁女性的病例，她在采取俯卧位旋转头部睡觉后，后循环区域发生了三次反复脑梗塞：第一次梗塞发生在右侧丘脑，随后是双侧小脑梗塞，最后是左侧小脑半球梗塞。颈动脉多普勒超声显示，头部旋转导致左侧椎动脉血流中断，数字减影血管造影显示，头部向一侧旋转导致左右旋转时对侧椎动脉血流中断。患者接受了C1-2后固定手术，使用螺钉和螺杆稳定了寰枢椎和轴，此后未再复发：结论：当遇到一觉醒来就复发后循环梗死的年轻患者时，询问患者的睡姿（如俯卧位）以评估头部旋转可能导致的椎动脉狭窄或闭塞至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.