The immediate brain effect of acupuncture at Fengchi in patients with posterior circulation ischemia vertigo:a resting-state functional MRI study / 实用放射学杂志

Objective To investigate the immediate brain effect of acupuncture at Fengchi using amplitude of low-frequency fluctuation(ALFF)and functional connectivity by the resting-state functional magnetic resonance imaging(rs-fMRI)in patients with posterior circulation ischemia vertigo(PCIV).Methods Twenty patients with PCIV were enrolled.The dizziness handicap inventory(DHI)was used to evaluate the severity of vertigo.The patients were randomly divided into acupuncture group and sham acupoint acupuncture group.Rs-fMRI scan was performed before and after acupuncture.MATLAB-based DPABI 6.1 software was used to analyze rs-fMRI data.Correlation analysis was used between the altered ALFF values and DHI scores.The regions of altered ALFF were taken as seeds to analyze functional connectivity.Results Compared with the sham acupoint acupuncture group,the increased ALFF values were mainly located on the left precuneus,left superior frontal gyrus and left caudate nucleus after acupuncture in the acupuncture group;the decreased ALFF values were mainly located on the left cerebellum and right inferior occipital gyrus.The ALFF value of the left superior frontal gyrus was negatively correlated with the DHI score(P=0.04).The increased functional connectivity was mainly found between left precuneus and the right middle frontal gyrus,the right superior frontal gyrus,the decreased functional connectivity was mainly found between left precuneus and the bilateral paracentral lobule and right cerebellum.Conclusion The ALFF value and functional connectivity are different before and after acupuncture,indicating that the vestibular network,visual and motor brain regions functional activities are changed after needling at Fengchi,which may be the brain functional basis of Fengchi for vertigo in PCIV.

Effects of edaravone dexborneol combined with argatroban on neurological function,hemorheology and hemodynamics of patients with acute cerebral infarction of posterior circulation / 临床神经病学杂志

Objective To investigate the effects of edaravone dextran combined with argatroban on neurological function,blood rheology and posterior circulation hemodynamics in patients with acute cerebral infarction in the posterior circulation.Methods One hundred and fifty-six patients with acute cerebral infarction in the posterior circulation were collected and randomly divided into the conventional treatment group,edaravone dextranol treatment group(EDD treatment group)and edaravone dextranol combined with argatroban treatment group(combined treatment group),with 52 cases in each group.The general data of patients in the three groups were collected,and the changes of NIHSS score and Barthel index,blood rheology and posterior circulation hemodynamics were evaluated before and after treatment in the three groups.Results After treatment,NIHSS scores and Barthel index were significantly lower in all three groups than before treatment(all P＜0.01).The NIHSS score and Barthel index of the combined treatment group were significantly lower than those of the EDD treatment group and the conventional treatment group after treatment(all P＜0.05).The difference in total effective rate among the three groups was statistically significant(P＜0.05),and the total effective rate among in combined treatment group was significantly better than those in the EDD treatment group and the conventional treatment group(all P＜0.05).The platelet aggregation rate,erythrocyte pressure volume,whole blood specific viscosity and plasma specific viscosity in the three groups after treatment were significantly lower than those before treatment(all P＜0.01).After treatment,the platelet aggregation rate,erythrocyte pressure volume,whole blood specific viscosity and plasma specific viscosity of combined treatment group were lower than those of EDD treatment group and conventional treatment group(all P＜0.05).Peak systolic blood flow velocity(Vs)of basilar artery,vertebral artery and posterior cerebral artery in the three groups after treatment were significantly higher than those before treatment(all P＜0.01),and resistance index(RI)was significantly lower than that before treatment(all P＜0.01).The Vs of basilar,vertebral and posterior cerebral arteries in the combined treatment group were significantly higher than those in the conventional treatment group and the EDD treatment group(all P＜0.05),and the RI was significantly lower than that in the EDD treatment group and the conventional treatment group(all P＜0.05).There was no significant difference in the comparison of adverse reactions among the three groups(all P＞0.05).Conclusion Edaravone dextranol combined with argatroban can exert a good protective effect on neurological function in patients with acute cerebral infarction in the posterior circulation by improving blood rheology and posterior circulation hemodynamics.

Brainstem auditory evoked potentials at high stimulation rates and posterior circulation ischemia / 中风与神经疾病杂志

@#Posterior circulation ischemia is an ischemic cerebrovascular disease frequently seen in clinical practice，which includes transient ischemic attack and cerebral infarction of the posterior circulation. The clinical manifestations of patients with posterior circulation infarction are complex and varied，and diagnosis is mainly based on clinical manifestations and imaging. Transient ischemic attacks in the posterior circulation have neither obvious positive signs nor typical imaging manifestations during the interictal period，making the diagnosis difficult. Brainstem auditory evoked potentials reflect the electrophysiological functioning of the auditory nerves and brainstem auditory conduction pathway. The use of brainstem auditory evoked potentials，especially brainstem auditory evoked potentials at high stimulation rates，in diagnosing posterior circulation ischemia expands and enriches diagnostic methods，which is of great significance for the early diagnosis of the disease. However，there are still many problems worth considering.

Clinical characteristics of sudden sensorineural hearing loss with acute cerebral infarction / 中华内科杂志

Objective:To analyze the clinical and imaging features of patients with sudden sensorineural deafness and acute cerebral infarction in order to provide evidence for early recognition of such diseases.Methods:This was a case series reporting study. A retrospective analysis was performed on the clinical and imaging data of 29 patients with sudden hearing loss (SHL) who admitted to the Otolaryngology Head and Neck Surgery Department of Beijing Tiantan Hospital from January 2017 to December 2021 and diagnosed with acute cerebral infarction using MRI-DWI.Results:The patients were aged 31-71 years, with an average age of 56±12 years, and 82.8% (24/29) were men. In total, 82.8% (24/29) of the patients had three or more atherosclerotic risk factors, and 24.1% (7/29) had a history of SHL. The hearing types were flat and total deafness: 86.2% (25/29) of the patients had severe hearing loss, 27.6% (8/29) had bilateral SHL, 17.2% (5/29) had further hearing loss during hospitalization, and 82.8% (24/29) had dizziness or vertigo at the onset. The signs of central nervous system involvement mainly included speech impairment, diplopia, dysphagia, central facial paralysis, facial and limb hypoesthesia, ataxia, and decreased muscle strength. Imaging evaluation showed that 21 cases were located in the posterior circulation supply area and 8 cases in the anterior circulation supply area. Additionally, 82.8% (24/29) patients had vertebrobasilar artery stenosis, and 58.6% (17/29) patients had severe vertebrobasilar artery stenosis or occlusion.Conclusions:Patients with SHL who progress to cerebral infarction often have multiple atherosclerotic risk factors and SHL. Most of the patients are middle-aged and older men who often complain of dizziness or dizziness accompanied by severe flat and total deafness with unilateral or bilateral SHL. Imaging findings suggest that most patients have posterior circulation infarction, often accompanied by severe stenosis or occlusion of the vertebrobasilar artery.

Safety and efficacy of endovascular treatment in patients with acute posterior circulation ischemic stroke over 24 hours from onset:a propensity score matched cohort study / 中国脑血管病杂志

Objective To explore the safety and efficacy of endovascular treatment(EVT)in patients with acute posterior circulation ischemic stroke over 24 hours from onset.Methods This retrospective study retrospectively analyzed patients with acute posterior circulation ischemic stroke who received EVT in the Department of Neurology,First Hospital of Jilin University from June 2018 to June 2023.The patient's gender,age and other related demographic information were collected.The related examination results of patients were collected,including admission rapid blood glucose,admission systolic blood pressure,admission diastolic blood pressure.The related risk factors of stroke of patients were collected,including previous transient ischemic attack,hypertension,diabetes,atrial fibrillation,and history of drinking,smoking history,etc.;other related indicators were collected,including intravenous thrombolysis,tandem lesions,awakening stroke,baseline National Institutes of Health stroke scale(NIHSS)score,and baseline posterior circulation Alberta stroke program early CT score(pc-ASPECTS),collateral circulation grade of American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR),onset to EVT puncture time,the trial of org 10172 in acute stroke treatment(TOAST)classification and outcome indicators(efficacy indicators included 90 days Modified Rankin scale[mRS]score≤3 after EVT,successful recanalization[extended cerebral infarction thrombolytic recanalization class 2b-3];security indexes included symptomatic intracranial hemorrhage[sICH]within 24 h after EVT and 90 d mortality after EVT).According to the symptom onset to EVT puncture time,the patients were divided into two groups:≤24h group and＞24h group.The patients with onset time＞24 h and those with onset time≤24 h were matched at a ratio of 1:1 by propensity score matching(PSM).All patients were divided into poor prognosis group(mRS score＞3)and good prognosis group(mRS score ≤ 3)according to mRS score at 90 days after EVT.Using univariate and multivariate Logistic regression was used to analyze the effect of onset time on clinical outcomes at 90 days after EVT.Results A total of 366 patients were enrolled in this study,including 284 males and 82 females.The median age was 61(55,68)years old,ranging from 25 to 91 years old.Before PSM,the＞24h group had lower prevalence of atrial fibrillation(2.02％[2/99]vs.9.74％[26/267],P=0.025)and lower baseline NIHSS score(10.0[5.0,19.0]vs.14.0[10.0,35.0],P＜0.01)and higher ASTIN/SIR collateral grade(P=0.018).After PSM,we did not find statistical difference between the two groups in baseline characteristics except for the onset to EVT puncture time.Before and after PSM,there was no significant difference in efficacy and safety between the onset time＞24 h group and the onset time ≤24h group.Univariate binary Logistic regression analysis showed that hypertension(OR,0.613,95％CI 0.391-0.942,P=0.025),intravenous thrombolysis(OR,3.235,95％CI 1.316-9.237,P=0.010),baseline NIHSS score(OR,0.975,95％CI 0.957-0.988,P＜0.01),baseline pc-ASPECTS(OR,1.281,95％CI 1.101-1.482,P=0.001)and sICH within 24 h after EVT(OR,0.070,95％CI 0.000-0.330,P＜0.01)were significantly correlated with prognosis.Gender,age,hypertension,baseline NIHSS score,intravenous thrombolysis,baseline pc-ASPECTS,ASTIN/SIR collateral grade,onset time＞24 h and sICH within 24 h after EVT were included in the multivariate binary Logistic regression analysis.The multivariate binary Logistic regression analysis showed that the onset time＞24 h was not associated with poor prognosis 90 d after EVT(aOR,1.635,95％CI 0.936-2.893,P=0.087).Conclusion EVT for acute posterior circulation ischemic stroke more than 24 hours after onset is feasible under strict imaging screening,and its safety and efficacy are similar to those in patients with onset under 24 hours.

Comparison of clinical prognoses of anterior and posterior circulatory large vessel occlusive ischemic stroke after successful endovascular recanalization / 中华神经医学杂志

Objective:To analyze the clinical characteristics of patients with anterior and posterior circulation large vessel occlusion ischemic stroke and clinical prognoses after successful endovascular recanalization.Methods:A retrospective analysis was performed; 170 patients with large vessel occlusive ischemic stroke, admitted to Stroke Center, Second Hospital of Dalian Medical University from January 2016 to September 2022 were chosen; these patients had modified Thrombolysis in Cerebral Infarction (mTICI) 2b or 3 after endovascular treatment. These patients were divided into anterior-circulation large vessel occlusion group ( n=138) and posterior-circulation large vessel occlusion group ( n=32) according to the locations of vessel occlusion. Clinical data, parameters related to endovascular treatment, and clinical prognoses of the 2 groups were collected and compared. Results:Posterior-circulation large vessel occlusion group had significantly higher percentages of male patients and patients with atherosclerotic type (81.3% vs. 61.6%; 78.1% vs. 47.1%), significantly higher ratio of neutrophil to lymphocyte and NIHSS scores (3.78 [1.93, 10.86] vs. 2.77[1.77, 4.72]; 20.50±8.96 vs. 14.83±4.67), significantly lower percentage of patients with atrial fibrillation (21.9% vs. 58%), and significantly longer times from onset to puncture, onset to recalculation, admission to puncture, and admission to recalculation (367.50 [246.25, 630.00] min vs. 240.00 [198.75, 330.00]; 515.00 [292.50, 701.25] vs. 345.50 [270.00, 425.75] min; 163.00 [123.25, 218.50] min vs. 125.50 [97.00, 161.00]; 258.00 [200.25,389.00] vs. 219.50 [178.00, 276.25]) than anterior-circulation large vessel occlusion group ( P<0.05). The NIHSS scores 24 h after endovascular treatment, NIHSS scores at discharge, and mortality within 90 d in posterior-circulation large vessel occlusion group were significantly higher than those in anterior-circulation large vessel occlusion group (21.31±9.23 vs. 15.74±6.53; 25.5 [4.25, 40.25] vs. 10.00 [4.00, 18.25]; 40.6% vs. 20.3%, P<0.05); however, no significant differences in symptomatic intracranial hemorrhage, incidence of intracranial hemorrhage, in-hospital mortality or 90-d good prognosis were noted between the 2 groups ( P>0.05). Conclusion:Posterior circulation large vessel occlusion ischemic stroke patients have higher neurological impairment at onset than anterior circulation acute large vessel occlusion ischemic stroke patients; both patients enjoy similar results in terms of 90-d good prognosis and complications, but 90-d mortality is higher than that in anterior ones.

Stroke syndrome: A case of a Nine syndrome with a DWI-negative imaging

@#The brainstem contains important structures that give an array of clinical manifestations in pathologic processes. Here, we report a case of “Nine Syndrome” who was admitted in our institution with no acute findings on DWI sequence. The exact prevalence of Nine Syndrome has been accounted to only four cases reported in the literature and this is due to a pontine tegmentum lesion. Our patient is a 65 year-old male who presented with five-hour history of sudden onset of symptoms presented as ipsilateral gaze palsy, internuclear ophthalmoplegia, a lower motor neuron type of facial palsy, and a contralateral hemiparesis. Using a 1.5T MR cranial scanner and Philips scanner of the time-of-flight of the intracranial vessels, no evidence of acute territorial infarct but an old lacunar infarct was seen in the right pontine area. Both the anterior and posterior circulations are within normal course and caliber with no narrowing seen. Patient was started on dual anti-platelet, high dose statin, and anti-hypertensives on the fourth hospital day. Nine syndrome is a rare case, and its diagnosis rely on its clinical manifestations, neuroanatomy, and diagnostic imaging. An acute posterior ischemic infarct such as this may yield a negative DWI finding but should not impede the clinician in its early recognition and management.

Analysis of electronystagmogram results in patients with vestibular migraine and posterior circulation infarction / 中风与神经疾病杂志

@#Objective　To compare and describe the characteristics of the VNG parameters of VM patients and PCI patients.Methods　This was a cross-sectional study.PCI and VM patients who were admitted to the Department of Neurology of Beijing Tiantan Hospital,Capital Medical University from November 2018 to November 2019,were examined for VNG.Results　The characteristics of VNG parameters were analyzed and compared.The abnormal rates of saccade,smooth pursuit,optokinetic test,gaze-evoked nystagmus,and spontaneous nystagmus in patients with PCI were significantly higher than patients with VM,while there was no significant difference in the rate of positional nystagmus;the two groups patients’ positional nystagmus were induced in various positions,and the duration was more than 60 s.Conclusion　The abnormal rate of optokinetic examination and spontaneous nystagmus of PCI patients was significantly higher than those in VM group.There was no significant difference in the abnormal rates of positional nystagmus.Video nystagmus may help distinguish the two diseases.

Preferred thrombectomy strategies for acute embolic occlusion of the vertebrobasilar artery: a comparative study / 中华神经医学杂志

Objective:To investigate the efficacy of different preferred thrombectomy strategies for embolic acute vertebrobasilar artery occlusion (AVBAO).Methods:Forty-four patients with embolic AVBAO who underwent endovascular treatment in Department of Neurology, Nanyang Central Hospital from January 2019 to June 2021 were included in the study. Patients were divided into stent-retriever thrombectomy group ( n=27) and aspiration thrombectomy group ( n=17) according to different preferred thrombectomy strategies. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients 90 d after surgery; the differences of clinical data, surgery-related characteristics, prognoses and complications between the two groups were compared. Results:There was no significant difference between the 2 groups in terms of time from onset to puncture, sites of target vessel occlusion, proportion of patients accepted intraoperative remedial measures, and successful recirculation rate of target vessels ( P>0.05). Compared with the aspiration thrombectomy group, the stent-retriever thrombectomy group had significantly decreased utilization rate of middle catheters, significantly increased retrieval attempts in thrombectomy, statistically lower re-recanalization rate of first-time thrombectomy on the target vessels, significantly longer time from puncture to re-recanalization, and significantly higher incidence of new embolism ( P<0.05). There was no significant difference between the 2 groups in incidences of vascular rupture and postoperative spontaneous intracerebral hemorrhage (sICH), and good prognosis rate 90 d after surgery ( P>0.05). Conclusion:For embolic AVBAO patients, similar recanalization and short-term good prognosis can be obtained by aspiration thrombectomy to those by stent-retriever thrombectomy; besides that, aspiration thrombectomy has advantages as shorter recanalization time, less new embolic complications and higher re-recanalization rate of first-time thrombectomy.

Influencing factors for early clinical deterioration in patients with mild posterior circulation infarction / 中华行为医学与脑科学杂志

Objective:To study the incidence and influencing factors for clinical deterioration at an early stage in patients with mild posterior circulation infarction (PCI).Methods:Totally 291 patients with mild PCI from January 1, 2016 to January 1, 2020 were retrospectively included. Clinical deterioration within 24 h (CD 24h) and clinical deterioration between 2 d and 14 d (CD 14d) were the endpoint events. IBM SPSS Statistics 19.0 software was used for statistical analysis. Pearson chi-square test or Mann-Whitney U test were used to compare the group differences of corresponding variables. Multivariate logistic regression model was used to analyze the influencing factors of the primary endpoint events. Results:The incidences of CD 24h and CD 14d were 21.6% (63/291) and 30.6% (89/291) respectively, with the reperfusion therapy rate of 13.4% (39/291). The results of multivariate logistic regression analysis with CD 24h as the endpoint event showed that the baseline NIHSS was a positive independent factor increasing the risk of CD 24h ( OR=1.184, 95% CI=1.078-1.300, P<0.01). Cerebellar infarction (compared with brainstem infarction) ( OR=0.250, 95% CI=0.082-0.757, P=0.014)and non-macroatherosclerosis (compared with major atherosclerosis) ( OR=0.026, 95% CI=0.002-0.325, P=0.005) had negative predictive effects on CD 24h. The results of multivariate logistic regression analysis with CD 14d as the endpoint event showed that pulmonary infection complications after stroke ( OR=28.085, 95% CI=6.863-114.927, P<0.01) and baseline NIHSS ( OR=1.114, 95% CI=1.001-1.240, P=0.048) were independent factors of CD 14d. Reperfusion therapy ( OR=0.089, 95% CI=0.013-0.613, P=0.014) could reduce the risk of CD 14d.Top of basilar syndrome(compared with single brainstem infarction) ( OR=7.526, 95% CI=1.565-36.188, P=0.012) increased the risk of CD 14d, while the non-macroatherosclerotic (compared with the macroatherosclerotic subtype) ( OR=0.076, 95% CI=0.009-0.683, P=0.021) negatively predicted the risk of CD 14d. Baseline NIHSS ( OR=0.834, 95% CI=0.758-0.918, P<0.01), CD 14d ( OR=0.048, 95% CI=0.018-0.130, P<0.01) and pulmonary infection complications ( OR=0.045, 95% CI=0.012-0.167, P<0.01) were negatively predicted the good clinical prognosis (modified Rankin score 14 days after onset ≤2). Conclusion:Early clinical deterioration has a negative predictive effect on clinical prognosis improvement of patients with mild PCI. Large artery atherosclerotic stenosis subtype and basilar apex syndrome are the risk factors of CD 24h and CD 14d of patients with mild PCI, and pulmonary infection is the risk factor of CD 14d. Reperfusion therapy in acute phase is helpful to reduce the risk of early clinical deterioration and improve clinical prognosis in patients with mild PCI.

Thirteen-and-a-Half syndrome stroke: A case report

@#We describe a 52-year old woman who developed one- and-a-half syndrome with an ipsilateral trigeminal and facial nerve palsy from a lacunar infarct of the left paramedian pontine area likely involving the median-paramedian perforators of the basilar artery.

Stroke syndromes: A case of an eight and a half syndrome

INTRODUCTION@#Eight and a Half syndrome: a combination of ipsilateral cranial nerve seven palsy plus one and a half syndrome is rare. Exact prevalence of the syndrome has not been reported as of yet. This syndrome is mostly attributed to a vascular etiology such as a pontine tegmental infarction. @*OBJECTIVE@#To present a rare case of a stroke syndrome : eight and a half syndrome (peripheral cranial nerve seven palsy plus a one and an half syndrome) in an adult male. To present the importance of its early clinical recognition in correlation of radiologic imaging, and management. @*CASE REPORT@#This is a case of a sixty-two year old male, who had a one day history of sudden double vision. Cranial nerve examination revealed a frozen right eye; unable to perform any movement on horizontal gaze, and with right sided facial asymmetry. He was hypertensive for more than ten years. Left eye was exotropic, with no adduction. Right eye was frozen on horizontal gaze, and primary gaze was at midline. Right sided peripheral facial palsy was seen on examination. Cranial non-contrast magnetic resonance imaging with time of flight was done revealing an infarct in the right posterior pontine area, and a narrow right vertebral artery due to a probable occlusion. Patient was started on antiplatelet cilostazol 100mg/tab 1 tablet twice daily. Atorvastatin 40mg/tab 1 tablet was given. Anti-hypertensives were started on his fourth hospital day. Smoking cessation, dietary modifications, and compliance to medications were emphasized prior to discharge. @*DISCUSSION@#Here we have a stroke syndrome presenting as an ipsilateral lower motor neuron: seventh nerve palsy, and an ipsilateral horizontal gaze palsy with internuclear ophthalmoplegia of the contralateral eye (failure of adduction) termed as CN VII, + 1 ½ syndrome or Eight and a Half Syndrome. This is caused by a lesion involving the paramedian pontine reticular formation (PPRF) which sends signals towards the ipsilateral abducens nerve and contralateral medial longitudinal fasciculus. These structures lie in close proximity to the nucleus and intraaxial fascicles of cranial nerve VII manifesting as facial weakness of the ipsilateral side to the lesion. An occlusion in the tip of the paramedian pontine artery, a branch of the basilar artery, is the most common etiology.

Comparison of predisposing factors，clinical presentations，and radiological features in patients with intracranial and extracranial posterior circulation artery dissection / 中风与神经疾病杂志

@#Cervicocerebral artery dissection（CAD） is an important cause of ischemic stroke in young and middle-aged individuals. At present，there are few studies on posterior circulation CAD. We compared the predisposing factors，clinical presentations，and radiological features in patients with intracranial and extracranial posterior circulation CAD. Methods Patients diagnosed with posterior circulation CAD in the last decade were enrolled. All patients were divided into the extracranial or intracranial group according to the lesion location of the dissection. The data of baseline characteristics，predisposing factors，clinical manifestations，and radiological features of the two groups were compared.Results A total of 59 patients were included in the study，including 33 patients in the intracranial posterior circulation CAD group and 26 patients in the extracranial group. The age of the extracranial group was younger than that of the intracranial group （P=0.0022）.The mean age was （45.12±13.33）and（34.85±10.57） years old，respectively. Smoking was more often in the intracranial group （51.52%） than extracranial group （15.54%，P=0.0013）. Additionally，a history of head or neck trauma was more frequently observed in the extracranial group compared with the intracranial group （26.92% vs. 6.06%，P=0.0269）.Headache was more common in the intracranial group. By contrast，neck pain was more frequently in the extracranial group.Conclusions The predisposing factors and clinical presentations of intracranial and extracranial CAD were different.These differences may help to distinguish intracranial and extracranial posterior circulation dissection.

Therapeutic Effect and Mechanism of Tongnao Pills in Treating Senile Posterior Circulation Ischemic Vertigo with Phlegm and Blood Stasis Type / 中国实验方剂学杂志

Objective:To explore the curative effect and mechanism of Tongnao pill in the treatment of senile posterior circulation ischemic vertigo with phlegm and blood stasis type. Method:The 80 elderly patients with posterior circulation ischemic vertigo (phlegm and blood stasis type) admitted to Gansu Provincial Hospital of Traditional Chinese Medicine were selected as the research subjects and were randomly divided into two groups according to the hospital admission number. Those with odd numbers were classified into control group and those with even numbers were classified into observation group, with 40 cases in each group. All of the patients in both groups were given basic treatment, and the patients in control group additionally received intravenous infusion of vinpocetine on the basis of basic treatment, while the patients in observation group additionally received Tongnao pill on the basis of the treatment in control group. The clinical efficacy, traditional Chinese medicine (TCM) syndrome score, European Evaluation of Vertigo(EEV) score, dizziness handicap inventory-screening (DHI-S) score, vertebral basilar artery average blood flow velocity(Vm) and pulsatility index(PI), hemodynamic changes[mean arterial pressure(MAP), central venous pressure(CVP), right atrial pressure (RAP), left atrial pressure(LAP), cardiac output(CO), cardiac stroke volume(SV)], changes in blood viscosity and blood lipid levels，symptom disappearance time, and safety of the two groups were compared. Result:The total effective rate in the observation group was 95.00% (38/40), significantly higher than 75.00% (30/40) in the control group (χ2=4.804, P<0.05). After treatment, the symptoms were significantly improved in both groups (P<0.05), and the scores of dizziness, nausea and vomiting, tinnitus and deafness, tiredness and fatigue in the observation group were lower than those in the control group (P<0.05), the EEV and DHI-S scores were decreased significantly in both groups(P<0.05), and such scores in the observation group were significantly lower than those in the control group(P<0.05), the Vm of bilateral vertebral artery (VA) and basilar artery (BA) on both sides were significantly increased in both groups, while the PI was significantly reduced (P<0.05), and these two indicators in the observation group were better than those in the control group (P<0.05), the MAP, CVP, RAP and LAP were significantly reduced in both groups after treatment, while the CO and SV were increased after treatment(P<0.05), and the SV of the observation group was significantly higher than that of the control group(P<0.05). The high blood viscosity, low blood viscosity, plasma viscosity and TG, TC, LDL-C levels were decreased significantly while HDL-C increased significantly in both groups (P<0.05), and the blood viscosity and blood lipid levels in the observation group were significantly better than those in the control group(P<0.05). The time to disappearance of dizziness, nausea, vomiting, tinnitus and deafness, malaise, fatigue, and confused mind in observation group was less than that in the control group (P<0.05), no serious adverse events occurred in both groups. Conclusion:Tongnao pills for the treatment of senile posterior circulation ischemic vertigo (phlegm and blood stasis type) can significantly alleviate the symptoms of vertigo, improve hemorrheology, increase the blood flow velocity of the vertebrobasilar artery, improve the abnormal blood supply to the brain, and improve the quality of life for patients, with fewer adverse reactions, high safety, and good therapeutic effect. Therefore, it is worth to be applied in clinical use.

Vertebral artery occlusion with lateral medullary syndrome and cervical cord infarct

@#Wallenberg syndrome (lateral medullary syndrome) is a type of posterior circulation stroke resulting in brainstem infarction which is most often caused by occlusion of vertebral artery or posterior inferior cerebellar artery or both.1 Here we report a case of right lateral medullary syndrome secondary to vertebral artery occlusion with associated left cerebellar and cervical cord infarct resulting in quadriparesis.

Effects of fast-twisting long-retaining acupuncture therapy on apoptosis and expression of related proteins in vestibular nucleus in rats with vertigo induced by posterior circulation ischemia / 中国针灸

OBJECTIVE@#To observe the effects of fast-twisting long-retaining (FTLR) acupuncture therapy on apoptosis of vestibular nucleus and expression of Caspase-3, Bcl-2 and Bax in rats with vertigo induced by posterior circulation ischemia.@*METHODS@#A total of 70 healthy SD rats were randomly divided into a sham operation group, a model group, a medication group, a regular acupuncture group and a FTLR acupuncture group, 14 rats in each group. The rats in the model group, medication group, regular acupuncture group and FTLR acupuncture group were intervented with surgical ligation of the right common carotid artery (CCA) and the right subclavian artery (SCA) to establish the model of vertigo induced by posterior circulation ischemia; in the sham operation group, the right CCA and the right SCA were separated without ligation. The rats in the medication group were treated with gavage of flunarizine hydrochloride suspension (10 mL/kg). "Baihui" (GV 20), "Shuaigu" (GB 8) and "Fengchi" (GB 20) were selected in the two acupuncture groups. The rats in the regular acupuncture group were treated with routine acupuncture and the needles were retained for 30 min, while the rats in the FTLR acupuncture group were treated with quick twist (200-300 times/min) for 1 min and the needles were retained for 60 min. The rats in the sham operation group and the model group received no intervention. All the intervention was provided once a day for 10 days. The decline rate of local blood flow in vestibular nucleus was observed; the apoptosis of vestibular nucleus was observed by TUNEL method; the expression of Caspase-3, Bcl-2 and Bax proteins were detected by immunohistochemistry.@*RESULTS@#Compared with the sham operation group, the decline rate of local blood flow in the right vestibular nucleus was significantly increased in the model group (<0.01), and the apoptosis index (AI) of vestibular nucleus was significantly increased (<0.01). Compared with the model group, the decline rates of local blood flow in the right vestibular nucleus in the two acupuncture groups and medication group were significantly reduced (<0.01), and the AIs of vestibular nucleus cells were significantly reduced (<0.01). The decline rate of local blood flow in the right vestibular nucleus in the FTLR acupuncture group was lower than those in the medication group and the regular acupuncture group (<0.01, <0.05), and the AI of vestibular nucleus was lower than those in the regular acupuncture group and the medication group (<0.05). Compared with the sham operation group, the expression of Bcl-2 in the vestibular nucleus was significantly decreased in the model group (<0.01), and the expressions of Bax and Caspase-3 were significantly increased (<0.01). Compared with the model group, the expressions of Bcl-2 in the vestibular nucleus were significantly increased in the two acupuncture groups and medication group (<0.01), and the expressions of Bax and Caspase-3 were significantly reduced (<0.01). The expression of Bcl-2 in the vestibular nucleus in the FTLR acupuncture group was higher than those in the regular acupuncture group and the medication group (<0.05), and the expressions of Bax and Caspase-3 were lower than those in the regular acupuncture group and the medication group (<0.05).@*CONCLUSION@#The FTLR acupuncture therapy could effectively inhibit the apoptosis of vestibular nucleus in rats with vertigo induced by posterior circulation ischemia, and its mechanism may be related to improving the blood supply of vestibular nucleus and regulating the expressions of Caspase-3, Bcl-2 and Bax proteins.

Clinical observation of the therapeutic effect on posterior circulation ischemic vertigo treated with "xiao xingnao kaiqiao" acupuncture / 针刺研究

OBJECTIVE: To observe the short-term and long-term clinical effect on posterior circulation ischemic vertigo treated with "xiao xingnao kaiqiao" acupuncture (minor regaining consciousness and opening orifice) and explore its effect mechanism. METHODS: Ninety patients with posterior circulation ischemic vertigo were randomly divided into a treatment group and a control group, 45 cases in each group. The patients of the two groups were all treated on the base of neurological medicine. In the control group, Flunarizine Hydrochloride was prescribed for oral administration (5 mg, once daily, for 21 days totally). In the treatment group, acupuncture of "xiao xingnao kaiqiao" was provided at Yintang (EX-HN3), bilateral Neiguan (PC6), bilateral Sanyinjiao (SP6), Baihui (GV20), bilateral Fengchi (GB20), bilateral Wangu (GB12) and bilateral Tianzhu (BL10). The needles were retained for 30 min, once daily for 21 days totally. The changes in vertigo score of traditional Chinese medicine (TCM) were observed, and the changes in the mean blood velocity (Vm) of the left vertebral artery (LVA), the right vertebral artery (RVA) and the basilar artery (BA) as well as the vascular pulsatility index (PI) were monitored and determined by transcranial Doppler (TCD). Additionally, the recurrence rate was followed up after 3 months to evaluate the long-term clinical effects. RESULTS: After treatment, the total effective rate of the treatment group was 91.11% (41/45) and 75.56% (34/45) in the control group. The total effective rate in the treatment group was higher than that in the control group (P<0.05). Compared with their own pre-treatment, the vertigo scores of TCM were reduced in either the treatment group or the control group after treatment (P<0.05) and the score in the treatment group was lower than that in the control group (P<0.05). Compared with their own pre-treatment, Vm and PI were all improved after treatment in either group (P < 0.05). After treatment, the improvements in Vm and PI of LVA、RVA and BA in the treatment group were better than those in the control group (P<0.05). In the follow-up after 3 months, the recurrence rate was 19.51% (8/41) in the treatment group and was 50.00% (17/34) in the control group. The recurrence rate in the treatment group was lower than that in the control group (P<0.05). CONCLUSION: "Xiao xingnao kaiqiao" acupuncture obviously relieves the clinical symptoms of posterior circulation ischemic vertigo. The mechanism of acupuncture is potentially related with its effects in improving Vm and PI of LVA,RVA and BA, as well as improving blood supply of brain tissue.

Comparative study of endovascular therapy in patients with large artery atherosclerosis and cardiogenic acute posterior circulation occlusion / 中风与神经疾病杂志

@#Objective In this study,the clinical data of single-center acute posterior circulation stroke patients were analyzed to compare the efficacy of TOAST classification for large artery atherosclerosis (LAA) and cardioembolism (CE) stroke patients after intravascular treatment difference.Methods Patient data comes from the advanced stroke center of the First Affiliated Hospital of Shihezi University School of Medicine,Xinjiang,China.According to the TOAST classification,the 98 people included were divided into LAA group and CE group.The mTICI score was used to evaluate vascular recanalization,the 90 day mRS score was used to evaluate the prognosis,the incidence of intracranial hemorrhage conversion within 72 hours and 90 day mortality Assess the safety of intravascular treatment.Results Among the 98 patients included in the study,79 were LAA stroke patients and 19 were CE patients.Compared with CE patients,LAA stroke patients are younger (60.08±12.64 vs 71.05±10.42,P=0.001),have a higher prevalence of hyperlipidemia (55.7% vs 22.1%,P=0.014),and preoperative systolic blood pressure higher (149.25±21.24 vs 134.79±22.83,P=0.010),lower NIHSS score (17.3 vs 22.2,P=0.025),better collateral circulation (ASITN/SIR score of 2~4 ratio,63.3% vs 21.1 %,P=0.002),the angioplasty rate is higher (31.6% vs 5.3%,P=0.040).However,the EVT recanalization rate (87.5% vs 84.2%,P=1.000) of the two groups of patients,the 90 day neurological function recovery rate (mRS score 0~2) (58.2% vs 36.8%,P=0.093),The incidence of postoperative intracranial hemorrhage transformation (1.3% vs 0%,P=1.000) and the 90 day stroke-related mortality (20.3% vs 42.1%,P=0.091) were not statistically significant.Conclusion s Although there were differences in baseline clinical data and clinical characteristics of EVT treatment between LAA and CE in posterior circulation,there was no significant difference in prognosis.

Bedside diagnosis of isolated transient vertigo in middle-aged and elderly patients / 中风与神经疾病杂志

@#Objective To study the common etiological components and bedside diagnostic skills of isolated transient vertigo (ITV).Methods We performed a single-center observational study that had consecutively recruited 424 middle-aged and elderly patients presenting with vertigo episodes lasted less than three minutes in the Neurology Department of Shanghai Tongji Hospital from January 2018 to January 2020.The clinical characteristics were collected and analyzed according to the established format and vertigo causes were analyzed.Binary Logistic regression analysis was used to determine some clinical parameters to benign paroxysmal positional vertigo (BPPV) and vascular ITV (vITV).Results In all 424 patients,BPPV accounted for 65.09% (n=276),vITV for 20.51% (n=87).Fifty-two cases (18.84%) of BPPV were diagnosed as posterior circulation ischemia (PCI) and 12 cases (14.63%) of vITV were suspected as BPPV.Logistic Regression analysis showed that onset time of vertigo<30 s,vertigo provoked by lying down or turning over in the supine position and typical nystagmus by positional maneuver were the independent predicted factors of BPPV (P<0.001).The higher risk of vITV was found in association with intolerance of head movement,trunk balance disturbance,spontaneous nystagmus and intolerance by positional maneuver (P<0.001).There was no independent correlation between vascular risk factors and vITV (P>0.05).Conclusion BPPV and vITV are the most common etiologies of ITV in the middle-aged and elderly patients.The etiology of ITV can be quickly and effectively distinguished by some specific clinical features and target bedside examinations.

Study of prognosis and influencing factors of circulatory infarction after intravascular intervention / 中风与神经疾病杂志

@#Objective　To investigate the prognosis and influencing factors of intravascular interventional therapy for posterior circulation infarction. Method　For selecting our department admitted in October 2019 and October 2017-two years hospitalized with a total of 42 cases of clinically diagnosed patients with posterior circulation infarction，patient gender，age，on admission，the main symptoms and signs，pathogenic factors，pathogenesis time interval，when to see a doctor to vascular disease opening time，lesion blood vessel parts，collateral compensatory，operation method choice and recanalization，vascular interventional treatment and postoperative 7 days before the NIHSS score，GCS score，mRS score when discharged from hospital，postoperative complications and prognosis of 90 days. According to the improved Rankin score of patients with 90-day prognosis，the patients were divided into a good prognosis group （mRS score <4 points） and a poor prognosis group （mRS score ≥ 4 points），and statistical analysis was conducted. Results　（1） For posterior circulation infarction，multiple interventional therapies were used to treat the lesion vessel opening rate of 71.4%，the 3-month mortality rate of posterior circulation infarction was 28.6%. And the good prognosis rate was 50%. （2）Univariate analysis suggested a statistically significant difference in the prognosis of patients with smoking P<0.01）. （3）Logistic regression analysis showed that after adjusting for cerebrovascular risk factors such as smoking，lower basilar artery occlusion was associated with poor prognosis. （4）Good intraoperative lesion vessels （Ⅱb level or Ⅲ level） and is related to good prognosis. Conclusion　Endovascular interventional therapy is an efficient and rapid method for posterior circulation infarction to open blood vessels. Good recanalization of diseased blood vessels during operation is positively correlated with good prognosis，while smoking and lower basilar artery occlusion are correlated with poor prognosis.