• 62 year old man who reproducibly experiences vertigo, nausea, and presyncope every time he turns his head to right
    • PMH: HTN, hyperlipidemia, DM
    • Meds: aspirin, pravastatin, glucophage, HCTZ

    Figure 1. Left vertebral artery

    Figure 2. Right vertebral artery

    Figure 3. MRI (C3-4 level)

    The next step in evaluating this patient would be:

    2. The patient likely has:

    3. Treatment for this patient would be:

    4. Which of the following describes you?

    5. I practice in one of the following locations.

    Please add any suggestions or comments regarding this case:

    • Osteophytic compression should be decompressed.
    • I have described series of similar cases in a poster presentation at the international stroke conference In Hawaii in February 2013. I suggested a new nomenclature of Rotational Vertebral Artery Ischemic Syndrome (RIVAS) to describe such phenomenon and classify each such case based on anatomical location and pathology rather than calling this kind of case a bow hunter syndrome which is misleading Stanley Kim, MD
    • I am a nurse practitioner in IL
    • Would likely fuse
    • Very nice case, congratulations
    • I had a patient who had this. Very interesting problem.
    • would stent and angioplasty, if sxs donot inprove then direct decompression should be a choice thx
    • It is very interesting
    • it is very tough case.wish you guys to write the final diagnosis and treatment
    • The diagnosis and treatment that i have given in my answer would normally have preceded the angiogram in my practice. If he were to fail this line of treatment, then only would he have proceeded to undergo a CT angiogram and perhaps followed by a catheter-angiogram
    • Interesting case. Clinical features are key of diagnosis. A correct approach for surgical decompression must be done as soon as possible due to the fact that the patient has undergone symptomatic for sometime long. A correct suspension of Aspirin prior surgery should be recommended. Luis Ordonez-Solorio MD, 4th-year resident Mexico City
    • Good case!

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site here. Privacy Policy