A Surgical Case of Bow Hunter’s Syndrome Diagnosed by Cervical Rotational MRA

Figure 1

Preoperative MRA shows normal flow and left VA dominant in the neutral position (a). MRA with neck rotation of 45 degrees revealed severe stenosis (arrow) of left VA (b). Preoperative cerebral angiograms of left VA show (c) normal flow in the neutral position and (d) severe stenosis at C3-4 level (arrow) and decreased flow on leftward neck rotation.

(a)

(b)

(c)

(d)