Bow Hunter Syndrome: Vertigo Caused by Head Turning

You check your blind spot before changing lanes, and the road suddenly tilts. Your vision blurs, your stomach drops, and the feeling fades once you face forward again. Most vertigo starts in the inner ear, but when spinning or lightheadedness shows up every time you turn your head to one side, a blood vessel in your neck may be the cause.

Bow Hunter Syndrome (BHS), also called rotational vertebral artery occlusion, happens when turning the head pinches one of the arteries that feed the back of the brain. BHS is less common than Benign Paroxysmal Positional Vertigo (BPPV), and the average age at diagnosis is 50. Similar to BPPV, vertigo or extreme dizziness are among the most common symptoms. Read on to learn how this rare condition develops and when you should look for the best doctor for vertebral artery stent and angioplasty in Lancaster for treatment.

What Happens Inside the Neck During Bow Hunter Syndrome?

Two vertebral arteries travel up through small bony openings in your neck bones before joining at the base of the brain. They supply the brainstem and cerebellum, which control balance, eye movement, and coordination. When you turn your head, bone or tissue can press on one vertebral artery and squeeze it shut. Most people have enough flow from the other artery to make up the difference. But if the opposite artery is small, narrowed, or blocked, you can experience dizziness. 

Common reasons the vertebral artery can get pinched include:

• Bone spurs from arthritis in the neck
• Thick ligaments or fibrous bands near the artery
• Bulging discs
• Vertebral artery stenosis
• An artery that follows an unusual path
• Looseness between the top two neck bones

The name Bow Hunter Syndrome comes from an early case involving a man who developed stroke symptoms while turning his head to draw a bow.

Vertigo Symptoms That Start When You Turn Your Head

Symptoms of Bow Hunter Syndrome usually begin within seconds of turning your head and ease once you return to center. If you suspect you may have BHS, you should watch for:

• Vertigo or a spinning sensation
• Dizziness or lightheadedness
• Blurred or double vision
• Nausea or vomiting
• Unsteady walking or loss of balance
• Numbness or weakness in the face, arms, or legs
• Fainting or nearly fainting

Repeated episodes can lead to a stroke in the back of the brain. Call 911 if symptoms do not go away after you straighten your head.

Do You Have an Inner Ear Vertigo or a Blood Flow Problem?

Benign paroxysmal positional vertigo, or BPPV, is the most common cause of position-related spinning. Comparing the two conditions can help you describe your symptoms to a specialist.

How Do Doctors Diagnose Bow Hunter Syndrome?

Standard scans taken with your head facing forward can look normal, so specialists need to see the artery while it is pinched. Testing may include:

• Transcranial Doppler ultrasound to measure blood flow as you turn your head
• A CT angiogram in both neutral and turned positions to show bone pressing on the artery
• Dynamic cerebral angiography, the gold standard, which maps blood flow through a catheter while you slowly rotate your head
• Brain MRI to check for small strokes from past episodes

Treatment Options for Bow Hunter Syndrome

Treatment for vertigo depends on whether you have a neurological cause for chronic vertigo or poor blood flow. Some people with mild symptoms do well with lifestyle changes and medication. But when you choose the best doctor for vertebral artery stenting and angioplasty in Lancaster, your care team will choose a treatment based on what pinches the artery and how severe your symptoms are. 

Treatment options may include:

• Avoiding the head positions that cause symptoms
• Blood thinners to lower the risk of clots
• Surgical decompression to remove bone that presses on the artery
• Fusion of the top neck bones when the joint is unstable
• Vertebral artery angioplasty and stenting for select patients who also have a fixed narrowing in the artery

Need to Find the Best Doctor for Vertigo in Lancaster? 

Our team at the Vascular and Neuroscience Institute uses transcranial Doppler studies, vascular imaging, and catheter-based angiography to find blood flow problems that standard scans can miss. 

In Lancaster, our team includes Dr. Nicholas Liaw, who completed a vascular neurology fellowship at UCLA and an interventional neurology fellowship in Toledo, Ohio. He also earned a doctorate in mechanical engineering, with research on the physical forces behind brain aneurysm formation. 

You can visit our Lancaster office in the same medical plaza as Antelope Valley Medical Center if you are looking for the best doctor for vertebral artery stenting and angioplasty in Lancaster.