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Recurrent strokes in a patient with bow hunter syndrome and comorbid atrial fibrillation: A case study Cover

Recurrent strokes in a patient with bow hunter syndrome and comorbid atrial fibrillation: A case study

Open Access
|Oct 2025

Abstract

Bow hunter’s syndrome (BHS) is a rare condition causing dynamic vertebral artery compression, which can result in recurrent strokes, posing unique challenges in patients with cardiovascular comorbidities like atrial fibrillation (AF). This case study describes the presentation, management and outcomes of a 75-year-old female with BHS and AF, who experienced recurrent posterior circulation strokes despite anticoagulation and antiplatelet therapy. A comprehensive stroke work-up, including advanced imaging, identified BHS as the primary cause. Despite adding aspirin to apixaban (Eliquis) and later switching to prasugrel (Efficient), the patient had another stroke, prompting vertebral artery embolisation. No further events occurred prior to the nine-month follow-up. Nurses play a crucial role throughout the patient’s journey and were instrumental in recognising BHS symptoms early, advocating for timely advanced imaging, and educating the patient on avoiding head rotation to minimise vertebral artery compression. They also monitored for complications, provided ongoing support during recovery, and contributed to improved patient outcomes through vigilant care and coordination with the multidisciplinary team. This case underscores the complexity of managing BHS in AF patients, highlighting the need for nuanced, multidisciplinary approaches and further research into the management of BHS in the context of other stroke risk factors.

DOI: https://doi.org/10.2478/ajon-2025-0013 | Journal eISSN: 2208-6781 | Journal ISSN: 1032-335X
Language: English
Page range: 44 - 51
Published on: Oct 10, 2025
Published by: Australasian Neuroscience Nurses Association
In partnership with: Paradigm Publishing Services
Publication frequency: 2 times per year

© 2025 Sheila Jala, Kaishin Tanaka, Aneeta Lal, Jean Paul Nguba Mbopey, Peter Lalor, Alice Powell, published by Australasian Neuroscience Nurses Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.