Division of Child Neurology, Department of Neurology, 10668Indiana University School of Medicine, Indianapolis, IN, USA.
Division of Pediatric Neurosurgery, Department of Neurosurgery, 10668Indiana University School of Medicine, Indianapolis, IN, USA.
J Child Neurol. 2020 Oct;35(11):767-772. doi: 10.1177/0883073820927108. Epub 2020 Jun 8.
Bow hunter's syndrome, or occlusion of the vertebral artery with head rotation leading to ischemia and sometimes stroke, is rarely described in children. The authors review the literature and present a new case.
Both OVID dating back to 1946 and PubMed records were reviewed using the terms ("Bow hunter syndrome" OR "bow hunter's") OR "rotational vertebral artery occlusion" combined with "child," and limited to English language. SCOPUS and the bibliographies of cases found in the search were used to identify additional articles.
Twelve articles were found describing 25 patients; there were 26 patients when combined with our case. Ages ranged from 1 to 18 years. Most (88.5%, 23/26) were male. Medical treatments included aspirin, clopidogrel, abciximab, enoxaparin, warfarin, and cervical collar. Stenting was tried in 2 cases but did not work long-term. Surgical treatments included decompression, cervical fusion, or a combination. We present a new case of a 12-year-old girl with recurrent stroke who had bilateral vascular compression only visible on provocative angiographic imaging with head turn. She was referred for cervical fusion, and abnormal ligamentous laxity was noted intraoperatively.
Bow hunter's syndrome is a rare but important cause of stroke since many of the patients experience recurrent strokes before the diagnosis is made. Reasons for the male predominance are unclear. Provocative angiography plays a key role in diagnosis, and both medical treatment and neurosurgical intervention may prevent recurrence.
弓猎者综合征，即椎动脉在头部旋转时发生阻塞导致缺血，甚至有时导致中风，在儿童中较为少见。作者复习了文献并报告了 1 例新病例。
通过使用“Bow hunter syndrome”或“bow hunter's”（OR）以及“rotational vertebral artery occlusion”的组合，在 1946 年回溯的 OVID 和 PubMed 记录中进行了检索，并且限制为英语语言。通过 SCOPUS 和在检索中找到的病例的参考文献，确定了其他文章。
共找到了 12 篇描述 25 例患者的文章；与我们的病例合并后共有 26 例患者。年龄范围从 1 岁到 18 岁，大多数患者（88.5%，23/26）为男性。医疗治疗包括阿司匹林、氯吡格雷、阿昔单抗、依诺肝素、华法林和颈托。2 例尝试了支架置入，但长期效果不佳。手术治疗包括减压、颈椎融合或两者结合。我们报告了 1 例 12 岁女孩的新病例，她反复发生中风，仅在头部旋转时的诱发性血管造影图像上可见双侧血管受压。她被转介进行颈椎融合，术中发现异常韧带松弛。
弓猎者综合征是中风的一个罕见但重要的原因，因为许多患者在做出诊断之前会反复发生中风。男性发病率高的原因尚不清楚。诱发性血管造影在诊断中起着关键作用，药物治疗和神经外科干预都可能预防复发。
