Effect of Modified Tongqiao Huoxuetang on Circulating Blood Flow and Wall Shear Stress Due to Blood Stasis and Channel Blockage / 中国实验方剂学杂志

Objective:To observe the effect of modified Tongqiao Huoxuetang on circulating blood flow and wall shear stress of vertebrobasilar dolichoectasia (VBD) due to blood stasis and channel blockage. Method:A total of 97 patients admitted in our department from October 2017 to August 2019 were collected. The traditional Chinese medicine (TCM) syndromes were consistent with blood stasis and channel blockage, and diagnosed as VBD by magnetic resonance angiography (MRA). The patients were divided into experimental group (48 cases) and control group (49 cases). Control group was given basic therapy and placebo of TCM, while treatment group was given basic therapy and modified Tongqiao Huoxuetang for 30 days. The degree of relief of vertigo symptoms, vertigo symptom scale (VSS), activity balance confidence (ABC), transcranial doppler (TCD) bilateral vertebral artery and basilar artery blood flow velocity [systolic blood flow velocity (Vs), mean blood flow velocity (Vm), diastolic blood flow velocity (Vd)], mean blood flow differences between (MFV), pulsatility index, resistance index (RI), and wall shear force (WSS) were observed before and after treatment. Result:Compared with control group before treatment, the score of ABC scale in control group after treatment was markedly higher, while the score of VSS was significantly lower (P<0.05). However, there was no statistical significance in the score of vertigo symptom. Compared with treatment group before treatment, the symptom grade of vertigo degree and the score of VSS in treatment group after treatment were substantially lower, while the score of ABC scale was significantly higher (P<0.05). Compared with control group, the score of vertigo degree symptoms and VSS in treatment group were markedly lower, while the score of ABC scale was significantly higher (P<0.05). Compared with control group before treatment, Vm, MFV and WSS of bilateral vertebral artery in control group after treatment were substantially higher, while RI was significantly lower (P<0.05). However, there were no statistical significances in Vs, Vd and PI in control group before and after treatment. Compared with treatment group, Vs, Vd, Vm, MFV and WSS of bilateral vertebral artery in treatment group after treatment were markedly higher, while RI was significantly lower (P<0.05). However, there was no statistical significance in PI of experimental group before and after treatment. Compared with control group after treatment, Vs, Vd, Vm, MFV and WSS of bilateral vertebral artery in treatment group after treatment were substantially higher, while there was no statistical significance in PI and RI. Before and after treatment, there were similar changes in blood flow parameters of the basilar artery and bilateral vertebral artery. Conclusion:Modified Tongqiao Huoxuetang could improve the clinical symptoms of dizziness or vertigo in patients of VBD due to blood stasis and channel blockage, and the mechanism might be related to the improvement of post-circulation hemodynamics by Tongqiao Huoxuetang.

Huge Vertebrobasilar Dolichoectasia

No abstract available.

Lower Cranial Nerve Palsy Due to Vertebrobasilar Dolichoectasia

No abstract available.

Effect analysis of microvascular decompression for patients with trigeminal neuralgia caused by vertebrobasilar dolichoectasia / 中国脑血管病杂志

Objective To preliminarily discuss the safety and efficacy of microvascular decompression for patients with trigeminal neuralgia caused by vertebrobasilar dolichoectasia (VBD).Methods From January 2013 to August 2016,16 patients with trigeminal neuralgia caused by vertebrobasilar dolichoectasia admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively.All patients received preoperative magnetic resonance angiography examination.The anatomical relationship between the trigeminal nerves and the peripheral vessels was identified.Microvascular decompression was conducted via suboccipital retrosigmoid approach.They were followed up for 12-52 months after procedure.The trigeminal neuralgia score standard of Barrow Neurological Institute was used to evaluate the degree of pain of the patients before procedure,after procedure,and during the follow-up period.Results Of the 16 patients,the pain disappeared immediately in 15 after procedure,and the pain was not obviously relieved in 1 case after procedure,and the pain disappeared gradually at 6 months after procedure.One patient had hearing loss after operation compared with pre-operation.The follow-up time ranged from 12 months to 52 months.Three patients had recurrent pain at 6,12,and 36 months,respectively after procedure.Conclusion Microvascular decompression treatment of trigeminal neuralgia caused by VBD has better safety and surgical efficacy,but there was a certain pain recurrence rate,which needed further research.

Preliminary experience of overlapping multi-stent angioplasty for the treatment of vertebral artery dolichoectasia / 中国脑血管病杂志

Objective To preliminarily investigate the safety and long-term efficacy of endovascular overlapping multi-stent angioplasty for the treatment of vertebral artery dolichoectasia.Methods From May 2009 to January 2011,the clinical and imaging data of 3 patients with vertebral artery dolichoectasia treated with overlapping multi-stent implantation at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were analyzed retrospectively.All 3 patients had prolongation and dilation on the left intracranial vertebral artery.One suffered compression of left medulla oblongata accompanied by old infarction of right thalamus,one complicated with ruptured aneurysm of left posterior cerebral artery received coil occlusion of the parent artery,and the other had a lacuna infarction on the left medulla oblongata with left intracranial vertebral artery dissection.Results 2-5 LEO stents were implanted into the left vertebral artery of each patient and the lesions were covered completely.The revascularization was successful in all patients and no perioperative complications occurred.The 3 patients were followed up for 5-8 years and no new clinical symptoms occurred.The modified Rankin scale score was 0.The DSA follow-up revealed that the vascular morphology of 2 cases was significantly improved compared with that before procedure.Conclusion The preliminary experience has shown that overlapping multi-stent angioplasty for the treatment of vertebral artery dolichoectasia is safe and the long-term effect of revascularization is satisfactory.

Vertebrobasilar Dolichoectasia in Fabry Disease: The Earliest Marker of Neurovascular Involvement?

Abstract Introduction: Fabry disease (FD) is a lysosomal storage disorder associated with marked cerebrovascular involvement. Conventional magnetic resonance imaging (MRI) shows different abnormalities, like white matter lesions that may already be present at an early stage in the disease. Aim: To present observations from a series of brain MRIs performed among a cohort of patients with FD and the relationship of imaging abnormalities with the presence of cardiovascular risk factors (CVRFs). Methods: A total of 70 patients with FD (43 women) were enrolled. The cardiac, renal, ophthalmic, and peripheral nerve functioning was assessed. The MRI evaluation included assessment for evidence of ischemia, microbleeds, pulvinar sign, Arnold-Chiari type 1 malformation, and vertebrobasilar dolichoectasia (VBD). The presence or absence of CVRFs was examined for all patients. Results: Renal involvement was found in 60%, cardiac compromise in 30%, cornea verticillata in 91.4%, and acroparesthesias in 87.1% of patients. Brain MRI analysis found evidence of cerebral ischemic injury in 25.9% of men and 30.2% of women. Vertebrobasilar dolichoectasia was observed in imaging from 55.5% of men and 34.8% of women. The logistic regression analysis adjusted for cardiovascular risks factors, using ischemia or VBD as a dependent variable, showed no statistically significant results. Discussion: Our results have demonstrated cerebrovascular involvement before the third decade in many patients with FD. This study is further evidence confirming that women are not just carriers of FD and should be followed clinically and evaluated comprehensively to monitor for disease burden and progression. Although silent brain ischemias in MRI should be included as a key feature for the diagnoses of FD, VBD is an earlier and frequent sign.

Treatment of a Ruptured Vertebrobasilar Fusiform Aneurysm Using Pipeline Embolization Device

Treatment options of ruptured vertebrobasilar fusiform aneurysms (VFA) are limited and often carry significant mortality and morbidity. We report the use of Pipeline Embolization Device (PED) to successfully treat a patient with a ruptured vertebrobasilar fusiform aneurysm (VFA) who presented with subarachnoid hemorrhage (SAH). A 73 year-old man with a history of cardiac stent placement seven days earlier presented with Hunt-Hess II SAH. He was taking aspirin and clopidogrel. Computed tomography angiogram revealed a large vertebrobasilar fusiform aneurysm. Microsurgical treatment options are technically challenging and carry high risk. He underwent endovascular treatment of the ruptured VFA using overlapping PEDs. Five PEDs were placed in a telescoping fashion to reconstruct the affected portions of the left vertebral and basilar arteries. An additional 2-mm blister aneurysm in the right vertebral artery was also discovered during the conventional cerebral angiography and was treated with one additional PED. The patient remained neurologically intact after the procedure. He was continued on aspirin and clopidogrel. Follow-up magnetic resonance imaging at three months demonstrated patency of the stents without any evidence of ischemic change. Follow-up conventional cerebral angiogram at six months demonstrated thrombosis of the VFA and reconstruction of the vertebrobasilar system. The patient remained clinically well. An endovascular approach using PEDs can be a safe and effective treatment option for ruptured VFA in selected cases.

The Effect of Microvascular Decompression for Hemifacial Spasm Caused by Vertebrobasilar Dolichoectasia

OBJECTIVE: Hemifacial spasm (HFS) caused by vertebrobasilar dolichoectasia (VBD) is very rare, and in theses cases, it is difficult to decompress the nerve from its vascular compression. The objective of this study was to investigate the outcome of microvascular decompression (MVD) for HFS caused by VBD. METHODS: There were 10 patients of HFS caused by VBD at our hospital between September 1978 and September 2008. We evaluated magnetic resonance angiography (MRA) and time of flight magnetic resonance imaginge (TOF MRI) findings using the criteria for VBD. We compared the clinical outcomes of MVD for the 10 patients with VBD with the overall outcomes of the total 2058 MVDs performed for HFS. RESULTS: The results of MVD for HFS caused by VBD were successful in 90.9% of cases. The postoperative complication rate in VBD was 45.5%. Offending vessels in patients with VBD were identified visually during surgery. Adverse effects after MVD were found in 4 patients. We found that the diameter of VBD was significantly greater in patients with complications than in those with no complications (p=0.028). CONCLUSION: Our data shows that MVD may be a good treatment modality for HFS caused by VBD but care must be taken to avoid adverse effects from the procedure. It is important to detach the dolichoectatic artery from its surrounding structures sufficiently to allow it to be easily movable. In addition, attempts should be made to lessen the retraction of the cerebellum during release of the dolichoectatic artery.

Analysis of Posterior Circulation Vascularity in Vestibular Neuritis

BACKGROUND: Vestibular neuritis (VN) is one of the most common causes of acute vertigo. Viral infection is regarded to be the most common etiology of VN, but other various causes including labyrinthine ischemia have not yet been fully elucidated. We assumed that labyrinthine ischemia can develop from various disorders in the posterior circulation including vertebral artery hypoplasia and vertebrobasilar dolichoectasia. METHODS: Fifty-six patients with acute VN and 56 healthy controls were enrolled. Two neurologists independently used magnetic resonance angiography (MRA) to retrospectively investigate the posterior circulation in VN patients. The relation between the presence of VN and abnormalities of posterior circulation vascularity was analyzed. RESULTS: MRA findings of vertebral artery hypoplasia and vertebrobasilar dolichoectasia were present in 15 (27%) and 14 (25%) of the VN patients. However, the frequencies of these findings did not differ significantly from those in the healthy controls (p=0.16). CONCLUSIONS: The frequencies of vertebral artery hypoplasia and vertebrobasilar dolichoectasia did not differ significantly between VN patients and healthy subjects. We suggest that brain MRI and MRA are not essential in acute VN patients without central signs. Large prospective studies are needed to characterize the vascular etiology of vestibular neuritis.

One Case of Downbeat Nystagmus with Compression of Vestibulocochlear Nerve by Vertebral Arteries

A case is reported of downbeat nystagmus associated with compression of the root of vestibulocochlear nerve by vertebral arteries, which was revealed by magnetic resonance imaging. Chief complain of the patient was positional vertigo, which aggrevated at left decubitus position. Downbeat nystagmus was increased in left Dix-hall pike test. Tetsuo et al, reported downbeat nystagmus with compression of dolichoectatic vertebral arteries to the medulla oblongata and surgical neurovascular decompression of the dolichoectasia reverses the progression of symptoms if permanent neurologic damage has not already occurred.

Vestibular Function Test in Old Age Patients with Vertebrobasilar Dolichoectasia

BACKGROUNDS: Most of vertebrobasilar dolichoectasia(VBD) patients are in old age. Cranial nerve dysfunction including vestibular dysfunction such as vertigo is frequent complications of VBD. But little is known about the vestibular function test(VFT) profile of the disease. METHODS: Auditory testing and VFT(electronysta-gmography with caloric test, rotaional test and computerized dynamic posturography) were performed in 25 elderly patients with auditory-vestibular symptoms or cranial nerve impairment associated with VBD. RESULTS: postive test results were observed in 22 cases(88%). 11 cases had evidence of peripheral involvement, 4 cases evidence of central impairment, and 7 cases had evidence of both peripheral and central dysfunction. CONCLUSION: Relatively high prevalence of central dysfunction means that mechanism such as ischemia or impaired blood supply to the vestibular system is as important as compression of the cranial nerves to generate vestibular dysfunction in elderly patients with VBD.