Vertebrobasilar insufficiency (VBI) provoked by physiological head rotation is 
known as rotational vertebral artery syndrome (RVAS) or Bow Hunter syndrome. 
RVAS most often occurs at C1-2 level with head rotation and presents with 
symptoms of VBI. Several previously published studies have reported RVAS at 
subaxial sites (V2 segment), however, tumor-induced RVAS has never been 
reported. The authors report the first case of RVAS at V2 segment due to 
compression from a spinal tumor. A 71-year-old man presented with symptoms of 
dizziness provoked by head rotation or neck extension. computed tomography (CT) 
angiography and dynamic cerebral angiography revealed circumferential stenosis 
with neutral neck position and complete occlusion of the left dominant vertebral 
artery (VA) at C5 level with his neck extended or rotated to the left. Complete 
neurological recovery was achieved after removal of a spinal osteochondroma and 
surgical decompression of the left VA via an anterior approach. Spinal tumors 
should be included in the differential diagnosis in cases of RVAS. Spinal 
degenerations or sarcomatous transformation of the tumor could lead to clinical 
manifestations of RVAS in cases with spinal osteochondroma. Complete removal of 
the tumor with or without spinal fusion would be the treatment of choice, in 
addition to medical treatment in the cases of acute stroke.