Bow Hunters Syndrome/Stroke-Rotational occlusion of vertebral artery

I only had a CT Head Neck Angiogram with contrast and am wonder if I need a Imaging B-mode transcranial color-coded duplex (TCCD) for a more accurate diagnosis.

My husband was told he has Bow Hunter's Syndrome by several local medical people who sent him to Mayo in 2021 for evaluation. He was seen by Neurology, the Spine Center, and Otolaryngology. No one did any dynamic scans. We were there is nothing wrong and he just should not put his neck in the position that causes him to black out. This means he has no life and cannot do the things he enjoys or drive for himself. We are continuing to try to find someone who can help. I am glad others have received vital help at Mayo, but I feel they failed my husband in this area. He had been a patient for many years at Mayo until this, but now it is difficult to get him to see any doctor for anything. If anyone has any suggestions as to what else we can try I would appreciate it.

I was suspected of having Bow Hunters Syndrome because I develop diplopia when I turn my head to left or right. To rule out this diagnosis, I was only given a CT scan of head and neck with IV Contrast. As I understand it from WebMD, “Your doctor may be able to spot the cause with imaging tests like an ultrasound, CT scan, or MRI (magnetic resonance imaging).

But the best way is a test called digital subtraction angiography, which is a sort of X-ray of your arteries. You might hold your head normally for one test, then move it in the direction that causes the problem for a second.” https://www.webmd.com/brain/bow-hunters-syndrome

I am not sure Mayo has this type of scan but if not, shame on them. Prior to my ACDF, I will have a consult with a Dr. Shepherd, who is a vascular medicine specialist, and am hopeful he will order at least a digital subtraction angiography. Other tests doctors should consider using include the color-coded Doppler test, magnetic resonance angiography; transcranial Doppler ultrasound; and vertebrobasilar deprivation testing, all of which I will discuss with Dr. Shepherd.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5495592/
Will try to keep you posted.

Thank you for the additional info. My husband had a severe allergic reaction to the contrast medium which left him with Stage 3 kidney failure immediately. He has had an MRA w/o contrast that showed nothing. The Mayo doc who ordered the MRA opted to not pursue things further. Yesterday the University of Iowa responded to the NeuroOpthamologist he sees locally with an appointment to evaluate him there in October. We are hoping to get some answers and hopefully treatment to prevent this life impacting syndrome. I will be interested to see how you make out. Good luck!

Didn’t they test your husband’s kidneys before giving him the contrast? They did mine. So sorry your husband had such a bad reaction. I’ll pray the cause of his symptoms is correctly diagnosed and he is able to recover fully!

Yes they did test BUT they ignored the patient had an allergy to iodine and was on a drug known to interact with iodine and damage the kidneys. The damage is permanent. Immediately after the test he collapsed and was rushed to the ER and put on saline IV drip but it was too late to reverse the damage. It is bad enough having diabetes and being supper careful to then have medical personnel blow it big time. Now we manage that and have been successful to prevent any further deterioration over these many years.

Oh wow!!! I am surprised Mayo staff would make such a careless mistake. Did you sue them? So very sorry that happened to your husband. Will keep both of you in my prayers! 🙏🙏🙏

Suing does not reverse a mistake or change the future. We filed a report with Patient Experience and told the ordering doctor, but have no way of knowing whether this reached the Radiology staff. Mistakes happen and you either waste time trying to return to where you were or grow stronger and more informed and move forward. We have found that moving forward and realizing doctors etc. are people too and they make mistakes. My husband had been told by his kidney specialist to never have contrast, but they talked him into it because their tests showed it would be "safe". We choose to look at this as both sides made a mistake and both sides paid a price. One in health issues and the other in the emotional freight. This just pointed out to us that you need to question any medical personnel and feel comfortable nothing is being overlooked. Appreciate all the prayer we get. Thank you.

Hi, @jdspouse

Mayo Clinic wants you to feel comfortable and confident about your care. Unfortunately, it sounds like your experience was not, and has not, been what you expected. I encourage you to follow up with the Office of Patient Experience to see if your original submission was received:

Mayo Clinic Office of Patient Experience
Phone: 844-544-0036 (toll free)
Email: opx@mayo.edu

I have had the same thing for years ... comes and goes can turn my head and almost black out ..2 minutes later do the same movement nothing happens .. finally had one old wise dr. tell me after he could not duplicate it say" it's going to get worse ..or better ... or not change ... but till we could duplicate each time then live with it and adjust your life accordingly" which I have for about 15 years or so .. have bouts of it but if I have a bout I try to make sure not to try testing it to see if I can make it happen again or each time ... if I do that it tends to fade away too much triggering is not good for it also .. was told it was a blood vessel going through an opening in my spine more than likely ..