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20 year old man with multiple strokes territories

Published byCecilia Mulder Modified over 6 years ago

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Presentation on theme: "20 year old man with multiple strokes territories"— Presentation transcript:

1 20 year old man with multiple strokes territories
Teaching NeuroImages Neurology Resident and Fellow Section © 2016 American Academy of Neurology

2 Vignette A 20 year-old healthy man Initial presentation
Transient right upper monoparesis MRI demonstrated left thalamic infarct. Two weeks later Left hemiparesis at basketball practice MRI demonstrated right thalamic infarct. Hypercoagulability and veno-arterial shunting risk-factor workup was unrevealing. See et al. © 2016 American Academy of Neurology

3 Imaging Diffusion-weighted brain MRI demonstrated left thalamic infarct (arrow, A). T2 brain MRI at re-presentation demonstrated right thalamic (arrow, B) and infratentorial infarcts. Anterior-posterior digital subtraction angiography with the head neutral (C) and with left vertebral occlusion when the head is turned to the right (D). 3-D reconstruction of left VA angiogram demonstrated the normal VA course (E) and focal dynamic occlusion (arrow, F) over the lateral mass of the second cervical vertebral body. See et al. © 2016 American Academy of Neurology

4 Dynamic vertebral artery insufficiency (Bow hunter syndrome)
Conventional angiography normal left vertebral artery (VA) course dynamic left VA occlusion during 36° rightward head turn. Bow hunter syndrome is eponymous for positional occlusion of the VA Bow hunter syndrome results in strokes from dynamic hypoperfusion He remains symptom-free one month after microsurgical clip sacrifice of the left VA Reference 1. Sorensen BF. Bow hunter’s stroke. Neurosurgery. 1978;2(3): See et al. © 2016 American Academy of Neurology

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