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Fighter Pilot Syndrome: A Bow Hunter Syndrome Variant Identified With Dynamic Cerebral Angiography.
Joo Won Choi1, Kirsten Jin2, Jessica N Wilson1,3
1John A. Burns School of Medicine University of Hawai'i at Mānoa Honolulu HI.
Stroke (Hoboken, N.J.)
|January 26, 2026
Summary
Dynamic compression of the vertebral artery, often caused by high G-forces in fighter pilots, can lead to recurrent embolic strokes. Dynamic cerebral angiography is key to diagnosing this rare condition.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Dynamic compression of extracranial arteries is a rare cause of ischemic stroke.
- Cervicocerebral arterial compression can lead to embolic events.
- Identifying the precise mechanism of arterial compression is crucial for stroke prevention.
Purpose of the Study:
- To present a case of recurrent embolic strokes caused by dynamic vertebral artery compression.
- To illustrate the diagnostic utility of dynamic cerebral angiography in identifying dynamic arterial occlusion.
- To highlight a unique cause of arteriogenic emboli in a specific patient population.
Main Methods:
- Retrospective chart review of a patient with recurrent embolic strokes.
- Detailed clinical history including occupational exposures (fighter pilot).
- Dynamic cerebral angiography to visualize arterial compression during provocative maneuvers.
Main Results:
- A young fighter pilot experienced recurrent strokes of undetermined origin.
- Dynamic compression of the right vertebral artery at the C4 level was identified.
- Specific in-flight maneuvers were correlated with dynamic vertebral artery occlusion.
Conclusions:
- Dynamic cerebral angiography is effective in diagnosing dynamic arterial compression.
- This case underscores the importance of considering occupational and anatomical factors in stroke etiology.
- Arteriogenic emboli can arise from previously unrecognized dynamic arterial compression syndromes.
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