Case Report: Bow Hunter Syndrome—One Reason to Add Non-gravity Dependent Positional Nystagmus Testing to Your Clinical Neuro-Otologic Exam

Michael C. Schubert, Nathaniel Carter, Sheng fu Larry Lo

Research output: Contribution to journalArticlepeer-review

Abstract

This case study describes transient downbeat nystagmus with vertigo due to a bilateral Bow Hunters Syndrome that was initially treated for 7 months as a peripheral benign paroxysmal positional vertigo. Normal static angiography and imaging studies (magnetic resonance, computed tomography) contributed to the mis-diagnosis. However, not until positional testing with the patient in upright (non-gravity dependent) was a transient downbeat nystagmus revealed with vertigo. The patient was referred for neurosurgical consult. Unfortunately, surgery was delayed due to suicidal ideation and hospitalization. Eventually, vertigo symptoms resolved following a C4-5 anterior cervical dissection and fusion. This case highlights the critical inclusion of non-gravity dependent position testing as an augment to the positional testing component of the clinical examination as well as the extreme duress that prolonged positional vertigo can cause.

Original languageEnglish (US)
Article number814998
JournalFrontiers in Neurology
Volume12
DOIs
StatePublished - Dec 20 2021

Keywords

  • Bow Hunter's syndrome
  • downbeat nystagmus
  • neurological examination
  • positional nystagmus
  • positional vertigo

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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