Bilateral Bow Hunter Syndrome Associated with Loss of Cervical Physiological Curvature.

BACKGROUND Bow hunter syndrome is a rare disease that is often overlooked. It presents with complex and variable clinical symptoms and causes, making diagnosis and treatment challenging. This case report focuses on a young patient with bilateral bow hunter syndrome, possibly caused by the loss of cervical physiological curvature. The aim is to enhance understanding and awareness of the disease. It is important to consider the possibility of bow hunter syndrome in young patients with long-term poor neck posture and symptoms such as dizziness, nausea, vomiting, and neck rotation-related symptoms. In such cases, thorough examination of posterior circulation hemodynamics and vascular morphology is recommended. CASE REPORT A 25-year-old woman was admitted to the hospital mainly because of "dizziness for 10 hours." The dizziness was aggravated when the right side of the neck was turned and the body position changed. This was accompanied by visual rotation, nausea, and vomiting. Bow hunter syndrome was diagnosed based on the clinical symptoms and hemodynamic examination of the posterior circulation. The patient was given a cervical collar to limit excessive twisting of the neck and instructed to avoid large-angle deflection of the neck after discharge. During the 3-month follow-up, no characteristic symptoms (such as dizziness) reappeared. CONCLUSIONS Bow hunter syndrome is a rare clinical posterior circulation compression syndrome with complex etiology. This case suggests that the simple disappearance of cervical curvature may be related to the occurrence of bow hunter syndrome. The dynamic monitoring of blood flow by color Doppler ultrasound and transcranial Doppler in different head positions provides clear clues to suspected bow hunter syndrome. With the help of computed tomography angiography, the diagnosis of bow hunter syndrome may be obtained by noninvasive examination.

New potential stimulation targets for noninvasive brain stimulation treatment of chronic insomnia.

BACKGROUND: Noninvasive brain stimulation (NIBS) was recently used as a therapeutic application in patients with insomnia. Most of the previous NIBS treatments for insomnia directly selected the dorsolateral prefrontal cortex (DLPFC) as the stimulation site. As the NIBS target is an important factor in the efficacy of NIBS, it is necessary to detect more potential cortical sites for NIBS in insomnia. METHODS: A neuroimaging study-based meta-analysis was used to examine sleep-related brain regions. A sleep-associated brain region-based functional connectivity (FC) map was constructed in 50 patients with chronic insomnia disorder (CID) without any comorbidity. We also combined the meta-analysis and FC results to examine the potential surface targets for NIBS for CID. RESULTS: The results identified the bilateral supplementary motor area (SMA), left superior temporal gyrus (STG), bilateral DLPFC, precentral lobule, supramarginal gyrus, angular gyrus, superior frontal gyrus, middle temporal gyrus and middle occipital gyrus as potential brain stimulation targets for insomnia treatment. Notably, the bilateral SMA, right DLPFC and left STG were identified in the FC and meta-analyses. In addition, the SMA and DLPFC were positively and STG was negatively connected with other sleep related brain regions, which indicated inhibitory and excitatory stimulation for NIBS treatment for CID, respectively. CONCLUSION: Our study suggests the SMA, DLPFC and STG as preferentially selected brain targets of NIBS for CID treatment. We recommend an inhibitory stimulation over SMA and DLPFC, and an excitatory stimulation over STG for NIBS treatment. Future studies should test these new targets using NIBS treatment for insomnia.

Headache and sick sinus syndrome: A case report.

BACKGROUND: Sick sinus syndrome is a common disease in cardiology. Typical symptoms include palpitations, dizziness, shortness of breath, chest tightness, and amaurosis. However, to date, there are no known reports of sick sinus syndrome presenting with headache. Whether there is a correlation between headache and sick sinus syndrome merits further research. In this report, we describe a case of headache induced by sick sinus syndrome. CASE SUMMARY: A 73-year-old female patient presented to our department with the chief complaint of recurrent paroxysmal headache for more than 7 years. The patient described paroxysmal palpations, usually headache occurring after palpitation. Her blood pressure was normal when the most recent headache occurred. A magnetic resonance imaging study and magnetic resonance angiography of the head at another center were normal. A clinical neurological examination was negative. A 24-h Holter electrocardiogram monitoring study showed sick sinus syndrome. The patient received dual chamber pacing implantation and was administered drug therapy to control ventricular rate. The patient's paroxysmal headaches and palpitations had resolved within 1 year, confirmed via a follow-up telephone call. CONCLUSION: After dual-chamber pacing implantation and drug therapy administration to control the ventricular rate, the patient's paroxysmal headaches and palpitations had resolved within 1 year, confirmed via a follow-up telephone call. We believe that the headaches were related to the patient's sick sinus syndrome.