Recurrent vertebrobasilar insufficiency—bow hunter’s syndrome

Abstract: Vertebrobasilar insufficiency manifests with vertigo, tinnitus, bulbar weakness and gait ataxia. Rotational compression of vertebral artery can occur at its atlantoaxial or subaxial segment. Bow hunter’s syndrome or rotational vertebrobasilar insufficiency is a rare condition with potential to cause posterior circulation infarction. We report a case of a 52-year-old male patient who presented with sudden onset vertigo, vomiting and gait ataxia. His magnetic resonance imaging (MRI) brain showed acute infarction in right cerebellar vermis with multiple gliotic areas in left cerebellar hemisphere suggestive of recurrent posterior circulation infarction. Dynamic MR angiography showed rotational compression of vertebral artery.