PDF(Pubmed)
Abstract：
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.
摘要：
我们介绍了一名年轻男性患者的情况，该患者经历了短暂的意识丧失，并在头部向后倾斜时表现出癫痫发作。经颅多普勒超声（TCD）和颈动脉超声（CAU）检查正常，患者颈部处于中立位置。然而,CAU显示在颈部旋转或向后运动期间椎动脉（VA）短暂闭塞。脑电图（EEG）监测是通过多次颈部旋转引起的测试进行的。病人出现头晕,这与第一次癫痫发作的前驱症状相同，脑电图显示额叶到额叶中线区域有大量的脊髓慢波和尖锐的慢波，偶尔会有泛化趋势。CT血管造影显示，当患者的头部向右旋转时，在VA的局部区域中缺乏造影剂填充。因此，患者被诊断为BowHunter综合征（BHS），并采取颈部固定保守治疗。随访3、6个月无复发。因此,该病例提醒神经科医生怀疑BHS在颈部旋转过程中观察到癫痫发作表现，CAU可能是BHS推荐的动态筛查方法。本报告伴随着对现有文献中的现象和诊断的讨论。
