Pediatric posterior ischemic stroke due to compression of vertenral artery: bow hunter’s syndrome

Abstract

Aims & Objectives: Acute traumatic stroke of the cerebellum is rarely seen in children. It may occur after minor trauma or by rotational movements of the head. Causes may include compression and/or injury of the posterior vertebral artery secondary to bone defect. One particular form, “Bow Hunter’s stroke”, originally described by Sorensen in 1978, results from vertebral-basilar insufficiency induced by head movements causing intermittent vertebral artery compression at the atlanto-axial junction. Acute ischemic lesions in this vascular territory should be suspected, and investigated using imaging studies such as CT and brain MRI.

Methods: We present a case of a 7-year-old male with unremarkable medical history, with subacute left hemiparesis. MRI shows acute ischemic stroke secondary to dissection of the posterior vertebral artery, then confirmed by conventional angiography. CT reconstruction showed presence of a bone spur compressing the spinal canal at the level of the Occipito-axial junction. Although anticoagulation was prescribed, a second event occurred 20 days later, when he experienced vomiting and loos of consciousness. After surgical resection of the bone defect, patient post-operative recovery was uneventful and no further ischemic events were observed.

Results: Surgical resolution

Conclusions: Underlying causes or structural anomalies predisposing to stroke should be carefully evaluated and ruled out, since most are treatable and recurrences can be prevented, as in this case.