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Updated: Jun 7, 2026
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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Rotational vertebral artery occlusion in a child with multiple strokes: a case-based update
Hansel M Greiner1, Todd A Abruzzo, Marielle Kabbouche
1Department of Neurology, Cincinnati Children's Hospital Medical Center, ML 2015, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA. hansel.greiner@cchmc.org
Summary
Rotational vertebral artery occlusion (RVAO) in children, often due to C1 vertebra anomalies, causes posterior circulation strokes. Surgical decompression of the vertebral artery (VA) is effective in preventing recurrent strokes.
Area of Science:
- Pediatric Neurology
- Vascular Neurology
- Neuroradiology
Background:
- Rotational vertebral artery occlusion (RVAO), or "Bow hunter syndrome," is a challenging cause of pediatric posterior circulation stroke.
- It results from vertebral artery compression by osseous or ligamentous structures.
Observation:
- A 15-year-old boy experienced recurrent posterior circulation ischemic strokes.
- Anomalous ossification of the C1 vertebrae was identified via 3D CT, with associated vertebral artery dissection on DSA.
- Dynamic angiography confirmed reversible VA occlusion during head turning.
Findings:
- Pediatric RVAO is frequently linked to congenital vertebral column anomalies, such as "ponticulus posticus" of the C1 vertebra.
- Dynamic angiography is definitive for diagnosing RVAO.
- Surgical decompression of the vertebral artery effectively prevents recurrent strokes.
Implications:
- High clinical suspicion for RVAO is crucial in children with posterior circulation stroke.
- Detailed analysis of 3D cervical spine CT images aids in diagnosing RVAO.
- Prompt diagnosis and surgical intervention can prevent long-term neurological deficits.
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