A case report of posterior circulation stroke in a young patient caused by Bow Hunter Syndrome

Background : Bow Hunter’s syndrome is an uncommon cause of transient vertebrobasilar insufficiency and posterior circulation stroke, resulting from dynamic mechanical compression of the vertebral artery during head rotation. Due to its low prevalence and variable clinical presentation, it may go unrecognized in young patients presenting with posterior circulation ischemic stroke. Case presentation : We report the case of a young male patient who presented with vertigo, vomiting, and occipital headache exacerbated by head rotation. Brain computed tomography (CT) revealed hypodense areas involving the cerebellar hemispheres and brainstem, with cerebellar infarctions confirmed on MRI. Computed tomography angiography (CTA) demonstrated asymmetric left vertebral artery course at V1 segment, hypoplasia of the V2 segment, as well as an anatomical variant of the left posterior inferior cerebellar artery (PICA). Dynamic digital subtraction angiography (DSA) showed cessation of flow during leftward head rotation at the left V1 level. Endovascular treatment with stent placement across the V1–V2 left segments was performed, achieving flow restoration and complete clinical recovery. Conclusion : Bow Hunter’s syndrome should be considered in patients with posterior circulation ischemic events and symptoms triggered by head movement. Dynamic angiographic studies remain essential for diagnosis, and endovascular treatment represents a safe and effective therapeutic option.