We herein present a rare case of BHS that was caused by compression of an extracranially originated PICA. This extracranial PICA could be compressed by head rotation and thereby cause BHS, but this situation has never been reported. It enters the cervical dural sac in parallel with the C2 nerve root ( 5). In some variations, it originates extracranially at the atlas–axis level, where it is associated with an embryonic remnant of the first intersegmental artery (FIA) ( 4). The posterior inferior cerebellar artery (PICA) is the largest branch of the VA, and its position is highly variable. BHS is not known to be caused by compression by any other artery except the VA. Compression of the non-dominant VA may also cause BHS, but this situation is rare ( 3). Compression of the dominant vertebral artery (VA) at the axis–atlas level of the cervical spine is commonly considered to be the cause when reduction of blood flow through the compressed VA is not compensated as expected by blood flow from the contralateral VA ( 2). The PICA could be a causative artery for BHS when it originates extracranially at the atlas–axis level, and posterior decompression is an effective way to treat it.īow hunter's syndrome (BHS) is a transient and symptomatic vertebrobasilar insufficiency that occurs during head rotation, resulting in dizziness and fainting ( 1). Following surgery, the patient's dizziness disappeared, and the stenotic change at the right VA and PICA improved. The patient underwent surgery to decompress the right PICA and VA via a posterior cervical approach. Occlusion of the PICA was considered to be the primary cause of the dizziness. During the head rotation that induced dizziness, the right PICA was occluded, and a VA stenosis was revealed. The right PICA originated extracranially from the right VA at the atlas–axis level and ran vertically into the spinal canal. On radiographic examination, the bilateral VAs merged into the basilar artery, and the left VA was predominant. A 71-year-old man presented with reproducible dizziness on leftward head rotation, indicative of BHS.
It has not been known to occur due to an extracranially originated posterior inferior cerebellar artery (PICA), the first case of which we present herein. Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japanīow hunter's syndrome (BHS) is most commonly caused by compression of the vertebral artery (VA).Noriya Enomoto Kenji Yagi * Shunji Matsubara Masaaki Uno
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