BACKGROUND: Bow Hunter's Syndrome is a mechanical occlusion of the vertebral 
artery which leads to a reduction in blood flow in posterior cerebral 
circulation resulting in transient reversible symptomatic vertebrobasilar 
insufficiency.
CASE DESCRIPTION: We present a case of Bow Hunter's syndrome in a 53-year-old 
male that occurred after the patient underwent surgical correction of a proximal 
left subclavian artery aneurysm. Shortly after the surgery, the patient began to 
complain of transient visual changes, presyncopal spells, and dizziness upon 
turning his head to the left. A transcranial doppler ultrasound confirmed the 
diagnosis of Bow Hunter's syndrome.
SYSTEMIC REVIEW: We analyzed the data on 153 patients with Bow Hunter's syndrome 
from the literature. An osteophyte was the most common cause of vertebral artery 
occlusion, and left vertebral artery was more commonly involved in patients with 
Bow Hunter's syndrome. Dynamic angiography was the definitive imaging modality 
to confirm the diagnosis, and surgery was most successful in alleviating 
symptoms.
CONCLUSION: We believe that this is the first case of iatrogenic Bow Hunter's 
syndrome after surgical intervention for an aneurysm repair, and the largest 
review of literature of Bow Hunter's syndrome. Dynamic angiography is the gold 
standard for the diagnosis of Bow Hunter's syndrome. Surgery should be 
considered as the primary treatment approach in these patients, especially those 
who have bony compression as the etiology.