{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T23:06:07Z","timestamp":1785884767972,"version":"3.56.0"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"8","license":[{"start":{"date-parts":[[2021,2,22]],"date-time":"2021-02-22T00:00:00Z","timestamp":1613952000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,22]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Bow hunter\u2019s syndrome or stroke (BHS) is characterized by rotational vertebrobasilar insufficiency elicited by rotation of the neck. It is caused by dynamic and reversible occlusion of the vertebral artery (VA). Reversible symptoms of rotational vertebrobasilar insufficiency are described as bow hunter\u2019s syndrome, although brain infarction is rarely reported as bow hunter\u2019s stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 70-year-old man experienced repeated cerebellar infarctions three times in the posterior inferior cerebellar artery (PICA) distribution of the nondominant right VA connecting the basilar artery. The onset of symptoms indicating cerebellar infarcts and the patient\u2019s head position changes were unrelated. Dynamic digital angiography (DA) revealed that the nondominant right VA was occluded by an osteophyte from the C4 vertebral body, and the right PICA branches were shown to be passing through the distal right VA from the left VA. These findings were observed when the patient\u2019s head was tilted to the right. An arterio-arterial embolic mechanism was suggested as the cause of repeated cerebellar infarctions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Transient nondominant VA occlusion has been rarely reported as a cause of BHS when the head is tilted. To confirm the diagnosis of BHS, additional head tilt is recommended when performing dynamic DA in patients with a cervical osteophyte.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2061","type":"journal-article","created":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T15:50:21Z","timestamp":1620143421000},"source":"Crossref","is-referenced-by-count":3,"title":["Repeated cerebellar infarction in the affected nondominant vertebral artery distribution with reversible vertebral artery occlusion elicited by head tilt: illustrative case"],"prefix":"10.3171","volume":"1","author":[{"given":"Takanori","family":"Nozawa","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kuwana Hospital, Niigata City, Japan;"},{"name":"Neurosurgery, Brain Research Institute, Niigata University, Niigata City, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kouichirou","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Departments of Translational Research and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Nakazato","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kuwana Hospital, Niigata City, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunio","family":"Motohashi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kuwana Hospital, Niigata City, Japan;"},{"name":"Neurosurgery, Brain Research Institute, Niigata University, Niigata City, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoaki","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Neurosurgery, Brain Research Institute, Niigata University, Niigata City, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kotaro","family":"Morita","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kuwana Hospital, Niigata City, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Tashi","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Neurosurgery, Brain Research Institute, Niigata University, Niigata City, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kuwana Hospital, Niigata City, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Kawashima","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukihiko","family":"Fujii","sequence":"additional","affiliation":[{"name":"Neurosurgery, Brain Research Institute, Niigata University, Niigata City, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"596","DOI":"10.3171\/jns.1965.23.6.0596","article-title":"Surgical treatment of vertebral artery insufficiency caused by cervical spondylosis","volume":"23","author":"Bakay L","year":"1965","unstructured":"Bakay L, Leslie EV. 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