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 journalArticlepeer-review

4 Scopus citations


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)
Pages (from-to)e28
JournalJournal of neurointerventional surgery
Issue number7
StatePublished - Jul 1 2017


  • Blood Flow
  • Cervical
  • Intracranial Pressure
  • Vein

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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