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Bow Hunter's syndrome with clicking sounds: A rare etiology of transient loss of consciousness with tonic–clonic seizure

We present the case of a young male patient experiencing a transient loss of consciousness and manifesting a seizure when he tilted his head backward. Transcranial Doppler ultrasound (TCD) and carotid artery ultrasound (CAU) examination were normal when the patient's neck was in the neutral pos...

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Autores principales: Wang, Lijuan, Dong, Yanan, Chen, Hongxiu, Bai, Jing, Zhu, Mingqin, Xing, Yingqi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878292/
https://www.ncbi.nlm.nih.gov/pubmed/36712445
http://dx.doi.org/10.3389/fneur.2022.1088842
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author Wang, Lijuan
Dong, Yanan
Chen, Hongxiu
Bai, Jing
Zhu, Mingqin
Xing, Yingqi
author_facet Wang, Lijuan
Dong, Yanan
Chen, Hongxiu
Bai, Jing
Zhu, Mingqin
Xing, Yingqi
author_sort Wang, Lijuan
collection PubMed
description We present the case of a young male patient experiencing a transient loss of consciousness and manifesting a seizure when he tilted his head backward. Transcranial Doppler ultrasound (TCD) and carotid artery ultrasound (CAU) examination were normal when the patient's neck was in the neutral position. However, the CAU revealed vertebral artery (VA) transient occlusion during neck rotation or backward movement. Electroencephalogram (EEG) monitoring was performed with multiple neck rotation–induced tests. The patient developed dizziness, which was the same as the prodromal symptoms of the first seizure, and the EEG showed a large number of spinal slow waves and sharp slow waves in the frontal-to-frontal midline area, with an occasional generalization trend. CT angiography revealed occipitalization of the atlas and the lack of contrast agent filling in the local area of the VA when the patient's head was turned contralaterally. Thus, the patient was diagnosed with Bow Hunter's syndrome (BHS) and treated conservatively with neck immobilization. No recurrence occurred at 3 and 6 months of follow-up. Therefore, this case alerts neurologists to suspect BHS on observing seizure manifestations during neck rotation, and CAU may be a recommended dynamic screening method for BHS. This report is accompanied by a discussion of the phenomenon and diagnosis in the context of the existing literature.
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spelling pubmed-98782922023-01-27 Bow Hunter's syndrome with clicking sounds: A rare etiology of transient loss of consciousness with tonic–clonic seizure Wang, Lijuan Dong, Yanan Chen, Hongxiu Bai, Jing Zhu, Mingqin Xing, Yingqi Front Neurol Neurology We present the case of a young male patient experiencing a transient loss of consciousness and manifesting a seizure when he tilted his head backward. Transcranial Doppler ultrasound (TCD) and carotid artery ultrasound (CAU) examination were normal when the patient's neck was in the neutral position. However, the CAU revealed vertebral artery (VA) transient occlusion during neck rotation or backward movement. Electroencephalogram (EEG) monitoring was performed with multiple neck rotation–induced tests. The patient developed dizziness, which was the same as the prodromal symptoms of the first seizure, and the EEG showed a large number of spinal slow waves and sharp slow waves in the frontal-to-frontal midline area, with an occasional generalization trend. CT angiography revealed occipitalization of the atlas and the lack of contrast agent filling in the local area of the VA when the patient's head was turned contralaterally. Thus, the patient was diagnosed with Bow Hunter's syndrome (BHS) and treated conservatively with neck immobilization. No recurrence occurred at 3 and 6 months of follow-up. Therefore, this case alerts neurologists to suspect BHS on observing seizure manifestations during neck rotation, and CAU may be a recommended dynamic screening method for BHS. This report is accompanied by a discussion of the phenomenon and diagnosis in the context of the existing literature. Frontiers Media S.A. 2023-01-12 /pmc/articles/PMC9878292/ /pubmed/36712445 http://dx.doi.org/10.3389/fneur.2022.1088842 Text en Copyright © 2023 Wang, Dong, Chen, Bai, Zhu and Xing. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Wang, Lijuan
Dong, Yanan
Chen, Hongxiu
Bai, Jing
Zhu, Mingqin
Xing, Yingqi
Bow Hunter's syndrome with clicking sounds: A rare etiology of transient loss of consciousness with tonic–clonic seizure
title Bow Hunter's syndrome with clicking sounds: A rare etiology of transient loss of consciousness with tonic–clonic seizure
title_full Bow Hunter's syndrome with clicking sounds: A rare etiology of transient loss of consciousness with tonic–clonic seizure
title_fullStr Bow Hunter's syndrome with clicking sounds: A rare etiology of transient loss of consciousness with tonic–clonic seizure
title_full_unstemmed Bow Hunter's syndrome with clicking sounds: A rare etiology of transient loss of consciousness with tonic–clonic seizure
title_short Bow Hunter's syndrome with clicking sounds: A rare etiology of transient loss of consciousness with tonic–clonic seizure
title_sort bow hunter's syndrome with clicking sounds: a rare etiology of transient loss of consciousness with tonic–clonic seizure
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878292/
https://www.ncbi.nlm.nih.gov/pubmed/36712445
http://dx.doi.org/10.3389/fneur.2022.1088842
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