Moving target: Transient rotational stenosis precipitating jugular bow hunter's syndrome

Waleed Brinjikji, Christopher S. Graffeo, Avital Perry, Terence Zimmerman, Jeffrey R. Janus, Pearce P. Morris, Gregory D Cascino, Giuseppe Lanzino

Research output: Contribution to journalArticle

Abstract

A 60-year-old man presented with a 10-month history of of stereotypical spells characterized by vertigo, tinnitus, blurred vision, left hemibody numbness, and occasional syncope, precipitated by turning his head leftwards. Cerebral angiography and CT angiography of the head and neck with provocative maneuvers did not demonstrate vertebral artery narrowing. However, there was narrowing of the left internal jugular vein due to extrinsic compression from the sternocleidomastoid with leftward head rotation in the setting of hypoplasia of the right internal jugular vein. The patient underwent a cervical venogram which confirmed the finding. Manometric evaluation demonstrated a gradient of 29 mm Hg across the stenosis with the head turned leftwards compared with 1 mm Hg in the neutral position. The patient was treated with myectomies of the left sternocleidomastoid, posterior belly of the digastric, stylohyoid and omohyoid and styloid process removal. Following surgery, the patient reported complete resolution of symptoms. Repeat venography demonstrated resolution of the stenosis and pressure gradient.

Original languageEnglish (US)
Article number012827
JournalBMJ Case Reports
Volume2016
DOIs
StatePublished - 2016

Fingerprint

Mucopolysaccharidosis II
Pathologic Constriction
Neck
Head
Jugular Veins
Cerebral Angiography
Hypesthesia
Vertebral Artery
Tinnitus
Phlebography
Vertigo
Syncope
Pressure

Keywords

  • Blood Flow
  • Cervical
  • Intracranial Pressure
  • Vein

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Brinjikji, W., Graffeo, C. S., Perry, A., Zimmerman, T., Janus, J. R., Morris, P. P., ... Lanzino, G. (2016). Moving target: Transient rotational stenosis precipitating jugular bow hunter's syndrome. BMJ Case Reports, 2016, [012827]. https://doi.org/10.1136/bcr-2016-012827

Moving target : Transient rotational stenosis precipitating jugular bow hunter's syndrome. / Brinjikji, Waleed; Graffeo, Christopher S.; Perry, Avital; Zimmerman, Terence; Janus, Jeffrey R.; Morris, Pearce P.; Cascino, Gregory D; Lanzino, Giuseppe.

In: BMJ Case Reports, Vol. 2016, 012827, 2016.

Research output: Contribution to journalArticle

Brinjikji, Waleed ; Graffeo, Christopher S. ; Perry, Avital ; Zimmerman, Terence ; Janus, Jeffrey R. ; Morris, Pearce P. ; Cascino, Gregory D ; Lanzino, Giuseppe. / Moving target : Transient rotational stenosis precipitating jugular bow hunter's syndrome. In: BMJ Case Reports. 2016 ; Vol. 2016.
@article{339539727448430ab0dafda323ff3666,
title = "Moving target: Transient rotational stenosis precipitating jugular bow hunter's syndrome",
abstract = "A 60-year-old man presented with a 10-month history of of stereotypical spells characterized by vertigo, tinnitus, blurred vision, left hemibody numbness, and occasional syncope, precipitated by turning his head leftwards. Cerebral angiography and CT angiography of the head and neck with provocative maneuvers did not demonstrate vertebral artery narrowing. However, there was narrowing of the left internal jugular vein due to extrinsic compression from the sternocleidomastoid with leftward head rotation in the setting of hypoplasia of the right internal jugular vein. The patient underwent a cervical venogram which confirmed the finding. Manometric evaluation demonstrated a gradient of 29 mm Hg across the stenosis with the head turned leftwards compared with 1 mm Hg in the neutral position. The patient was treated with myectomies of the left sternocleidomastoid, posterior belly of the digastric, stylohyoid and omohyoid and styloid process removal. Following surgery, the patient reported complete resolution of symptoms. Repeat venography demonstrated resolution of the stenosis and pressure gradient.",
keywords = "Blood Flow, Cervical, Intracranial Pressure, Vein",
author = "Waleed Brinjikji and Graffeo, {Christopher S.} and Avital Perry and Terence Zimmerman and Janus, {Jeffrey R.} and Morris, {Pearce P.} and Cascino, {Gregory D} and Giuseppe Lanzino",
year = "2016",
doi = "10.1136/bcr-2016-012827",
language = "English (US)",
volume = "2016",
journal = "BMJ Case Reports",
issn = "1757-790X",
publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Moving target

T2 - Transient rotational stenosis precipitating jugular bow hunter's syndrome

AU - Brinjikji, Waleed

AU - Graffeo, Christopher S.

AU - Perry, Avital

AU - Zimmerman, Terence

AU - Janus, Jeffrey R.

AU - Morris, Pearce P.

AU - Cascino, Gregory D

AU - Lanzino, Giuseppe

PY - 2016

Y1 - 2016

N2 - A 60-year-old man presented with a 10-month history of of stereotypical spells characterized by vertigo, tinnitus, blurred vision, left hemibody numbness, and occasional syncope, precipitated by turning his head leftwards. Cerebral angiography and CT angiography of the head and neck with provocative maneuvers did not demonstrate vertebral artery narrowing. However, there was narrowing of the left internal jugular vein due to extrinsic compression from the sternocleidomastoid with leftward head rotation in the setting of hypoplasia of the right internal jugular vein. The patient underwent a cervical venogram which confirmed the finding. Manometric evaluation demonstrated a gradient of 29 mm Hg across the stenosis with the head turned leftwards compared with 1 mm Hg in the neutral position. The patient was treated with myectomies of the left sternocleidomastoid, posterior belly of the digastric, stylohyoid and omohyoid and styloid process removal. Following surgery, the patient reported complete resolution of symptoms. Repeat venography demonstrated resolution of the stenosis and pressure gradient.

AB - A 60-year-old man presented with a 10-month history of of stereotypical spells characterized by vertigo, tinnitus, blurred vision, left hemibody numbness, and occasional syncope, precipitated by turning his head leftwards. Cerebral angiography and CT angiography of the head and neck with provocative maneuvers did not demonstrate vertebral artery narrowing. However, there was narrowing of the left internal jugular vein due to extrinsic compression from the sternocleidomastoid with leftward head rotation in the setting of hypoplasia of the right internal jugular vein. The patient underwent a cervical venogram which confirmed the finding. Manometric evaluation demonstrated a gradient of 29 mm Hg across the stenosis with the head turned leftwards compared with 1 mm Hg in the neutral position. The patient was treated with myectomies of the left sternocleidomastoid, posterior belly of the digastric, stylohyoid and omohyoid and styloid process removal. Following surgery, the patient reported complete resolution of symptoms. Repeat venography demonstrated resolution of the stenosis and pressure gradient.

KW - Blood Flow

KW - Cervical

KW - Intracranial Pressure

KW - Vein

UR - http://www.scopus.com/inward/record.url?scp=85007105421&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85007105421&partnerID=8YFLogxK

U2 - 10.1136/bcr-2016-012827

DO - 10.1136/bcr-2016-012827

M3 - Article

C2 - 27999126

AN - SCOPUS:85007105421

VL - 2016

JO - BMJ Case Reports

JF - BMJ Case Reports

SN - 1757-790X

M1 - 012827

ER -