Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Bow Hunter's Syndrome Caused by Bilateral Dynamic Occlusion of the Subaxial Vertebral Arteries during Neck Extension

경추 신전 시 축하 척추동맥의 양측성 동적 폐쇄로 인해 발생한 보우 헌터 증후군

  • Yi, Jemin (Department of Orthopaedic Surgery, Dankook University College of Medicine) ;
  • Han, Ho Sung (Department of Orthopaedic Surgery, National Medical Center)
  • 이제민 (단국대학교 의과대학 정형외과학교실) ;
  • 한호성 (국립중앙의료원 정형외과)
  • Received : 2019.11.19
  • Accepted : 2019.12.03
  • Published : 2020.02.28
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Abstract

Bow hunter's syndrome is a rare disease that shows the symptoms of vertebrobasilar insufficiency resulting from a dynamic obstruction or stenosis of the vertebral arteries during neck movement. This paper reports a case of a 59-year-old male who visited the emergency room with diplopia, tinnitus, and gait disturbance. Magnetic resonance imaging and angiography revealed a multiple cerebellar infarct, total obstruction of the right vertebral artery, and dynamic obstruction of the left vertebral artery during neck extension. As the infarction worsened, a thrombectomy was done. Posterior decompression and fusion at C5-6 were performed for the left vertebral artery. The left vertebral arterial patency was confirmed by intraoperative and postoperative angiography. No recurrence of the symptoms was observed for six months after surgery. Physicians need to pay attention to the diagnosis of vertebrobasilar insufficiency caused by an obstruction of the vertebral arteries during neck extension in cervical instability patients.

보우 헌터 증후군은 경추의 운동 시 척추동맥의 동적 폐쇄나 협착으로 인해 척추기저동맥의 혈행 장애의 증상을 나타내는 드문 질환이다. 증례의 59세 남자 환자는 복시, 이명, 보행장애를 주소로 응급실에 내원하였다. 뇌 자기공명영상 및 뇌혈관조영술상 다발성 소뇌 경색이 있었다. 우측 척추동맥은 이미 완전 폐쇄되었고 좌측 척추동맥은 경추 신전 시에 동적 폐쇄가 발생함이 확인되었다. 경색이 악화되어 혈전 제거술을 시행하였으며 좌측 척추동맥에 대해 제5-6 경추간 후방 감압술 및 유합술을 시행하였다. 수술 중 및 수술 후 시행한 혈관조영술상 좌측 척추동맥의 혈행이 원활함이 확인되었으며 수술 후 6개월 추적관찰 동안 증상의 재발은 없었다. 경추 불안정증이 있을 경우, 경추 신전 시 척추동맥이 패쇄되어 척추기저동맥 혈행 장애를 유발할 수 있으므로 진단에 유의해야 한다.

Keywords

References

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