Bow hunter’s syndrome (BHS) is clinical manifestation of dynamic compromise of vertebral artery. Dynamic imaging with provocative digital subtraction angiography (DSA) is a preferred modality but non-invasive bed side screening tool for a dynamic compression of the vertebral artery is needed.A 56-year-old man developed cervicalgia and syncope while manipulating his neck. Cervical spine CT and MR angiography demonstrated osteophyte with uncovertebral hypertrophy at left C5/6 level and right vertebral artery hypoplasia. Transcranial doppler (TCD) sonography on midbasilar artery revealed sudden disappearance of basilar flow while the patient moved his neck extended and left twisted. The patient was instructed not to move his neck to provoking position and discharged without any medication. This is a report of bedside, non-invasive and early approach of clinically suspected BHS with TCD. Journal of Neurosonology 6(1):16-19, 2014 Key Words: Bow hunter’s syndrome, Transcranial doppler sonography, Osteophyte, Vertebrobasilar insufficiency