BACKGROUND: Bow hunter's syndrome, or occlusion of the vertebral artery with 
head rotation leading to ischemia and sometimes stroke, is rarely described in 
children. The authors review the literature and present a new case.
METHODS: Both OVID dating back to 1946 and PubMed records were reviewed using 
the terms ("Bow hunter syndrome" OR "bow hunter's") OR "rotational vertebral 
artery occlusion" combined with "child," and limited to English language. SCOPUS 
and the bibliographies of cases found in the search were used to identify 
additional articles.
RESULTS: Twelve articles were found describing 25 patients; there were 26 
patients when combined with our case. Ages ranged from 1 to 18 years. Most 
(88.5%, 23/26) were male. Medical treatments included aspirin, clopidogrel, 
abciximab, enoxaparin, warfarin, and cervical collar. Stenting was tried in 2 
cases but did not work long-term. Surgical treatments included decompression, 
cervical fusion, or a combination. We present a new case of a 12-year-old girl 
with recurrent stroke who had bilateral vascular compression only visible on 
provocative angiographic imaging with head turn. She was referred for cervical 
fusion, and abnormal ligamentous laxity was noted intraoperatively.
CONCLUSIONS: Bow hunter's syndrome is a rare but important cause of stroke since 
many of the patients experience recurrent strokes before the diagnosis is made. 
Reasons for the male predominance are unclear. Provocative angiography plays a 
key role in diagnosis, and both medical treatment and neurosurgical intervention 
may prevent recurrence.