JNNP: Arch Hunter Syndrome: A rare case of bilateral dynamic occlusion of vertebral arteries

A 54-year-old man complained of occasional tinnitus and blurred vision for 2 years.
For many years, especially when driving, his symptoms were related to turning his head to the right
.
Neurological examination highlighted the reported symptoms appearing in the right side of the neck torsion more than 45°

The dynamic CE-MRA scan performed during the right head rotation showed bilateral stenosis of the vertebral artery at the right C5–C6 level (A, white arrow) and the left C2 level (B, black arrow)

The dDSA image shows normal left ventricular diameter and blood flow in a neutral position (a) During right brain rotation (B), blood flow interruption (white arrow) is observed due to dynamic stenosis at the C2 level (black arrow)
.
Note the reperfusion of the ascending carotid artery at the same level (black arrow)

BHS is a rare neurovascular disease characterized by insufficient blood flow in the posterior cerebral circulation caused by dynamic occlusion of VA and head rotation
.
Symptomatology depends on the compensatory blood flow, ranging from short-term dizziness, fainting, nystagmus, tinnitus to thrombus embolism