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.

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 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.

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.

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.

The manifestation of videonystamography in the patients with posterior circulation ischemia vertigo / 临床耳鼻咽喉头颈外科杂志

To investigate the changes of vedionystamography(VNG)in patients with posterior circulation ischemia vertigo(PCIV).Fifty patients who complained of vertigo and imbalance with PCI were selected as experimental group for testing of visual nystamography(VNG).Thirty normal subjects were chosen as control group.The result was analyzed.The results of VNG in PCIV group and the control group were compared.The abnormal ratio were as follows:(4%,0;>0.05)for Spontaneous nystagmus,(68%,10%;<0.01)for Saccade Test,(42.0%,6.7%;<0.01)for Tracking Test,(44%,0;<0.01)for Optokinetic Test,(78%,10%;<0.01)for Positional Test,respectively.The intensity of positional nystagmus in those patients was(4.12±3.46)°/s,which was much higher than that of the control group(<0.01).One or more abnormal findings for visual-oculomotor system examination were shown in 37 patients(74%).Both vestibular central and peripheral system can be involved in PCIV.VNG test has clinical significance in differential diagnosis and lesion location.The abnormal ratio of visual nystamography in PCIV group reaches 92%(46/50).These results suggest that VNG be used as an important accessory diagnostic tool for patients with PCIV.

Types of vertebral artery occlusion and their compensatory hemodynamic changes influence to posterior circulation ischemia / 中国脑血管病杂志

Objective To evaluate the correlation between the types of vertebral artery occlusion and their compensatory hemodynamic changes and posterior circulation ischemia using color Doppler flow imaging combined with transcranial color-coded sonography.Methods From June 2015 to June 2016,A total of 108 patients with vertebral artery occlusion confirmed by vascular sonography,digital subtraction angiography (DSA) or CT angiography (CTA) were enrolled retrospectively.According to the magnetic resonance imaging (MRI)-diffusion weighted imaging (DWI) findings,they were divided into posterior circulation infarction (n=78 in infarction group) and non-posterior circulation infarction (n=30 in TIA group).Color Doppler flow imaging and transcranial color Doppler ultrasonography were used to examine the contralateral vertebral artery extracranial diameter, peak systolic velocity(PSV) and end diastolic velocity(EDV) of bilateral extracranial and intracranial vertebral arteries.The differences of the vertebral artery occlusion types,establishment of collateral circulation and hemodynamic changes of the contralateral vertebral artery were compared between the two groups.Results The patients with single vertebral artery occlusion in the infarction group and TIA group were 69 (88.5%) and 26 (86.7%) respectively;those with bilateral vertebral artery occlusion were 9 (11.5%) and 4 (13.3%) respectively.There was no significant difference in the number of vertebral artery occlusion between the two groups (χ2=0.000,P=1.000).The proportion of patients with vertebral artery occlusion in intracranial segment in the infarction group was higher than that in the TIA group (70.5% [55/78] vs.36.7% (11/30);χ2=10.444,P=0.001).The proportion of patients with the establishment of collateral circulation in the infarction group was lower than that in the TIA group (14.1% [11/78] vs.43.3% (13/30);χ2=10.711,P=0.001).The peak systolic velocity (PSV) and the end diastolic velocity (EDV) of contralateral extracranial vertebral artery in patients with single vertebral artery occlusion in the TIA group were higher than those in the infarction group (65±21 cm/s vs.57±15 cm/s,25±8 cm/s vs.20±7 cm/s,t=2.043 and 2.606 respectively,all P<0.05).Conclusion The establishment of collateral circulation and hemodynamic compensation of the contralateral vertebral artery after vertebral artery occlusion were closely associated with the occurrence of posterior circulation ischemia.

Effect of evaluation of vertebrobasilar artery atherosclerosis on the progress of posterior circulation ischemia with high-resolution magnetic resonance imaging / 中国脑血管病杂志

Objective To investigate the value of evaluating vertebrobasilar artery atherosclerosis with 3.0 T high-resolution magnetic resonance imaging (HR-MRI) in the progress of posterior circulation transient cerebral ischemia (TIA).Methods From July 2013 to July 2014,30 consecutive patients (outpatients and inpatients) with posterior circulation TIA at the Department of Neurology,the First People's Hospital of Changshu were enrolled respectively.They were all confirmed as the presence of vertebrobasilar atherosclerotic plaques by the head magnetic resonance angiography.The vertebrobasilar artery plaques were examined with 3 T HR-MRI to assess the nature and stability of the plaques.They were randomly divided into either a stable plaque group (n =16) or an unstable plaque group (n =14) according to the results of plaque stability.They were followed up for 24 months.The time and proportion from the first visit to the posterior circulation infarction were recorded and compared between the two groups of patients.Results At the end of follow-up,the time of posterior circulation infarction in the unstable group was significantly shorter than that in the stable group,and the difference was statistically significant (11.5 [7.0,20.0] months vs.24.0[22.5,24.0] months,Z =-2.755,P ＜ 0.05).The ratios of posterior circulation infarction in the stable group and the unstable group were 5/16 and 8/14 respectively.The difference was not statistically significant between the two groups (P ＞ 0.05).Conclusion Evaluating the results of vertebrobasilar artery atherosclerosis plaque with HR-MRI has a certain value for the progression of posterior circulation ischemia disease.

Clinical observation on Danshen Chuangxiongqin Injection in treatment of posterior circulation ischemia vertigo / 药物评价研究

Objective To observe the clinical effect of Danshen Chuangxiongqin Injection in treatment of posterior circulation ischemia vertigo.Methods Patients (80 cases) with posterior circulation ischemia vertigo attack in Anhui Hospital of Traditional Chinese from March 2015 to March 2017 were randomly divided into control and treatment groups,and each group had 40 cases.Patients in control group were treated by Betahistine mesylate,6 mg/time (3 times/d) for 2 weeks.Patients in treatment group were iv administered with Danshen Chuangxiongqin Injection (10 mL/d) added into normal saline 250 mL,once daily for 2 weeks.After treatment,the efficacy was evaluated,and the levels of blood viscosity index,fibrinogen in two groups before and after treatment were compared.Results Total effective rate of observation group was 92.5％ which was higher than the control group's 72.5％ with significant difference (P ＜ 0.05).After treatment,the laboratory indexes (levels of blood viscosity,fibrinogen,and so on) were decreased,the improvement degree of these indexes in treatment group were significantly better than those in control group,with significant difference between two groups (P ＜ 0.05).Conclusion Danshen Chuangxiongqin Injection has significant effect in treating posterior circulation ischemia vertigo and it is worthy of clinical application and promotion.

Effect of Zhuang Medicine Acupuncture on Brainstem Auditory Evoked Potential in Patients with Posterior Circulation Ischemic Vertigo / 上海针灸杂志

Objective To investigate the effect of Zhuang medicine acupuncture on brainstem auditory evoked potential (BAEP) in patients with posterior circulation ischemic vertigo (PCIV).Methods Eighty-five PCIV patients were randomly allocated to a treatment group of 45 cases and a control group of 40 cases. The control group received conventional basic therapy and the treatment group, Zhuang medicine acupuncture in addition. The peak latencies (Pg) of BAEP waveⅠ ,Ⅰ andⅠ and the interpeak latencies (IPg) of waveⅠ-Ⅰ,Ⅰ-Ⅰ andⅠ-Ⅰ were compared between the two groups after treatment.Results There were statistically significant post-treatment differences in waveⅠ andⅠ Pg and waveⅠ-Ⅰ andⅠ-Ⅰ IPg between the treatment and control groups (P<0.05).Conclusions Zhuang medicine acupuncture plus medication is an effective way to treat PCIV. It can improve BAEP indicators in the patients.

Effect of remote limb isehemic postconditioning on posterior circulation ischemia vertigo / 中华神经医学杂志

Objective To study the effect of remote limb isehemic postconditioning (RLIPC) on posterior circulation ischemia vertigo (PCIV). Methods Seventy patients with PCIV, admitted to our hospital from January 2013 and June 2014, were randomly divided into control group and therapy group (n=35). The patients of control group were treated with routine medicine, and those of therapy group were treated with RLIPC and routine medicine. Before and after treatment, dizziness assessment rating scale (DARS) and dizziness handicap inventory (DHI) scale were used to evaluate the changes of manifestations; peak systolic velocity (PSV) and end diastolic velocity (EDV) of vertebra artery (VA) were evaluated by colour doppler ultrasound. Results Before treatment, no significant differences on DARS and DHI scores were noted between the two groups (P>0.05); after treatment, , the DARS and DHI scores in the therapy group were 26.03±4.24 and 60.91±10.15, respectively, which were significantly decreased as compared with those in the control group (28.80±5.16 and 68.11±12.44, t=2.388 and 2.584, P=0.000); PSV and EDV of VA in the therapy group were 49.97±7.69 and 16.90±2.80, respectively, which were significantly increased as compared with those in the control group (47.31±7.47 and 15.12± 2.74, t=-2.505 and-2.631, P=0.015 and 0.011). Conclusions RLIPC could alleviate the symptoms of PCIV, which might be related to increased blood flow of VA. RLIPC is simple and safe, and can be used in the treatment of PCIV.

Morphological changes of vertebral-basilar artery in patients with posterior circulation ischemia ;vertigo / 中国脑血管病杂志

Objective To investigate the morphological characteristics of vertebral-basilar artery in patients with posterior circulation ischemia vertigo. Methods The data of cerebrovascular disease related risk factors,neck CT angiography,and head MR angiography of 122 patients with posterior circulation ischemia vertigo and 60 non-vertigo volunteers with cerebrovascular disease related risk factors over the same period were analyzed retrospectively. The positive index of single factor comparison was analyzed by using multivariate logistic regression analysis. The risk factors for posterior circulation ischemia vertigo were screened,and the degree of vertebral artery stenosis and the degree of basilar artery tortuosity of the posterior circulation ischemia group were compared with those of the control group. Results (1 )The incidences of hypertension,hyperlipidemia,previous history of stroke or transient ischemic attack,vertebral artery atherosclemtic stenosis,vertebral artery variation,and basilar artery tortuosity of the posterior circulation ischemia group were 59%(n=72),55. 7%(n=68),64. 8%(n=79),41. 0%(n=50),28. 7%(n=35),and 30. 3%(n=37),respectively,and they were all significant higher than 33. 3%(n=20),31. 7%(n=19),35. 0%(n=21),15. 0%(n=9),10. 0%(n=6),and 15. 0%(n=9)of the control group. There were significant differences (all P<0. 05). (2)Vertebral artery atherosclerotic stenosis (OR,3. 891, 95%CI 1. 721-8. 800,P <0. 01),vertebral artery variation (OR,3. 231,95%CI 1. 238-8. 432,P =0.017),and basilar artery tortuosity (OR,2. 664,95%CI 1. 189-5. 972,P=0. 017)were the independent risk factors for posterior circulation ischemic vertigo. The degrees of vertebral artery stenosis and basilar artery tortuosity of the posterior circulation ischemic group were higher than those of the control group. There were significant differences (all P<0. 05). There was significant difference in the vertebral artery dominance between the degree of basilar artery tortuosity ≥grade 2 and

Relationship between Homocysteine,Glycosylated Hemoglobin, Lipids and Posterior Circulation Ischemia / 现代检验医学杂志

Objective To explore the relationship between homocysteine(HCY),glycosylated hemoglobin(HbA1c),lipids and posterior circulation ischemia and the clinical significance of their levels in the posterior circulation ischemic (PCI)diseases. Methods Difference between PCI were diagnosed in 140 examinees and a healthy control group,with fasting serum,HCY, HbA1c,total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C)and low-density lipoprotein cholesterol (LDL-C)were detected.Results HCY and HbA1c were significantly higher,HDL-C was significantly lower in the patients with PCI,two independent sample t-test showed a significant difference between the test group and control group (P <0.001 and P =0.001),the remaining lipid indicators was not statistically significant.Spearman rank correlation analysis showed that HCY levels had significant positive correlation (P <0.001)and TG levels had significant negative cor-relation (P =0.013)with the subjects age,HCY levels had significant negative correlation with TG levels(P = 0.028), HbA1c levels had significant positive correlation with TG levels and LDL-C levels(P =0.001 and P =0.027).Conclusion High levels of HCY and HbA1c were closely associated with PCI,which HCY and HbA1c should be attached great impor-tance to the effective prevention and treatment and improve of PCI.

Pure tone threshoIds and Otoacoustic Emissions in PCI Patients without Hearing Loss CompIaints / 听力学及言语疾病杂志

Objective To study the audiometry and otoacoustic emissions in patients with posterior circulation ischemia(PCI) .Methods Forty patients treated by neurologists were selected as the experimental group who re_ceived pure tone audiometry ,tympanometry ,otoacoustic emissions (OAE) and distortion products otoacoustic emis_sions (DPOAE) examinations .Thirty healthy objects were chosen as the control group .The data from the PCI groups and the control group were compared using the SPSS 14 .0 software .ResuIts The difference in pure tone thresholds across 125 to 8 000 Hz between the PCI group and the control group was not statistically significant (P>0 .05) .In the PCI patients ,the prevalence of TEOAE was only 47 .5% ,significantly different from that of in the control group .The prevalence of DPOAE at 0 .5~8 kHz were between 57 .9% ~77 .6% in PCI patients ,and the amplitudes of DPOAE were reduced significantly (P<0 .05) .ConcIusion Cochlear damages can occur to patients with PCI ,especially in the high frequency range .These results suggest that OAE can be used as an important diag_nostic test for patients with PCI ,and might be helpful for the location diagnosis of PCI .

Clinical Observation of Kudiezi Injection Combined with Alprostadil in the Treatment of Posterior Circula-tion Ischemic Vertigo / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of Kudiezi injection combined with alprostadil in the treat-ment of posterior circulation ischemic vertigo. METHODS:Totally 180 patients with posterior circulation ischemia were randomly divided into group A,group B and group C. All patients were given aspirin,atorvastatin,nutrition nerve,antihypertensive,hypo-glycemic and other conventional treatment. On this basis,group A was given Alprostadil injection 10 μg,adding into 0.9% Sodium chloride injection 100 ml,iv,once a day;Kudiezi injection 30 ml,adding into 0.9% Sodium chloride injection 250 ml,iv,once a day. Group B was given Alprostadil injection(the same usage as group A);group C was given Kudiezi injection(the same usage as group A). The course was 14 d. The clinic data was observed,including clinical efficacy;blood flow velocity in left vertebral ar-tery(LVA),blood flow velocity in right vertebral artery(RVA),blood flow velocity of basilar artery(BA),changes of peak laten-cy(PL)and incubation period latency(IPL)before and after treatment;and the incidence of adverse reactions. RESULTS:The to-tal effective rate in group A was significantly higher than group B and C,with significant difference(P0.05). There were no obvious adverse reactions during treatment. CONCLUSIONS:Kudiezi injection combined with alprostadil has better effica-cy than only Kudiezi injection or alprostadil in the treatment of posterior circulation ischemic vertigo,with good safety.

Effects of butylphthalide combined with naloxone on the treatment of posterior circulation ischemic vertigo (PCIV) / 医学研究生学报

Objective Vertigo is the main clinical feature and cerebral atherosclerosis is the major etiological factor and pathogenesy of posterior circulation ischemia (PCIV).The objective of this study was to observe the clinical effect of butylphthalide combined with naloxone on PCIV and hemodynamics . Methods One hundred and sixty two patients with PCIV were classified into treatment group and control group .In the treatment group , butylphthalide soft capsules were administrated by oral and naloxone 2.4 mg were administrated by intravenous drip per day .In the control group , Xueshuantong at the dose of 300 mg was given by intravenous drip per day.All the treatment lasted for 14 days.Transcranial doppler (TCD) examination was performed for all patients before and after the treatment.The mean velocity (Vm) and the systolic velocity (Vs) of bilateral vertebral arteries were recorded .Clinical cure rate was evaluated . Results Basilar artery Vm and Vs increased after treatment in the control group compared with those before treatment ([30.15 ±3.84])cm/s vs ([26.95 ±3.72])cm/s, ([40.87 ±4.54])cm/s vs ([37.16 ±4.72])cm/s.Basilar artery Vm and Vs increased after treatment compared with before treatment in the treatment group ([34.47 ±3.53]) cm/s vs ([27.53 ± 3.68])cm/s, ([42.25 ±5.29])cm/s vs ([35.87 ±4.85])cm/s, (P<0.05).Basilar artery Vm and Vs increased in the treatment group compared with the control group after the treatment ([34.47 ±3.53])cm/s vs ([30.15 ±3.84])cm/s, ([42.25 ±5.29])cm/s vs ([40.87 ±4.54])cm/s, (P<0.05).The cure rate and total effective rate in the treatment group (58.8%, 93.8%) were higher than thoes in the control group, respectively (31.7%, 75.6%)(P<0.05). Conclusion Butylphthalide soft capsules combined with naloxone have definite clinical curative effect and few side for PCIV treatment.

Investigation of the recent prognosis of vertebral artery dominance in patients with posterior circulation transient ischemic attack / 中国现代医生

Objective To research the recent prognosis of vertebral artery dominance in patients with posterior circula-tion transient ischemic attack. Methods All 120 patients were diagnosed with posterior circulation transient ischemic attack from January 2012 to October 2013 hospitalization, collected the vertebral artery MRA, clinical data ABCD2 score, the incidence of cerebral infarction within 7 days with the patients, and compared the differences. Results The share of vertebral artery dominance was higher than non-vertebral artery dominance in the posterior circulation TIA. According to ABCD2 score stratification, the incidence of cerebral infarction was rising from low-risk group to the risk group to the high-risk group. 7 days after TIA, the incidence of cerebral infarction in group with the vertebral artery dominant compared with the non-vertebral artery dominance had significant difference (P<0.05). If ABCD2 score<4 points, there was no significant difference in incidence of cerebral infarction between the group with vertebral artery dominant and non-vertebral artery dominance (P>0.05). If ABCD2≥ four points, the result was opposite (P<0.05). Conclusion The vertebral artery dominance is one of the risk factors for cerebral infarction to the patient with posterior circulation TIA. ABCD2 score in the high-risk patients'risk of vertebral artery advantage is particularly evident.

An analysis of clinical features of 226 vestibular migraine patients / 中华内科杂志

Objective To explore the clinical characteristics of vestibular migraine in patients from the clinic and ward of the neurological department in comprehensive hospitals.Methods A total of 226 patients diagnosed as vestibular migraine were enrolled in the study.Clinical data were collected and analyzed,including the medical history,clinical symptoms and signs,as well as the result of diagnostic examinations.Results The mean age of the patients at the visit was 51.7 years old,with the male to female ratio of 1:1.48.The occurrence of vertigo and migraine varied in order,with 53.1％ (120/226) patients presented migraine several years before vertigo.The duration time of vertigo ranged from seconds to days,with 1.8％ (4/226) patients presented no headache during the whole course.Several punctate long T2 or high FLARE (fluid attented inversion recovery) signals scattered at the centrum ovale.Conclusions Vestibular migraine has complex mechanism and presents multiple clinical manifestations with certain regularities of the onset.Differential diagnosis should be made from the similar diseases.

Curative Effect of Vinpocetine Combined with Danhong Injections in the Treatment of Posterior Circulation Ischemia Syndrome / 中国药师

Objective:To observe the curative effect of vinpocetine combined with Danhong injections in the treatment of posterior circulation ischemia syndrome. Methods:Totally 120 patients with posterior circulation ischemia syndrome were selected and randomly divided into the treatment group and the control group with 60 cases in each. Both groups were treated by the conventional therapy, meanwhile, the treatment group was given vinpocetine and Danhong injections, and the control group was given vinpocetine alone. The treatment course was 14 days. The curative effect was observed, blood rheology and hemodynamics were also studied. Results:The to-tal effective rate of the treatment group was 95. 0%, which was significantly higher than that of the control group (75. 0%) with statis-tically significant difference(P<0. 05). After the treatment, the blood rheology (viscosity, low shear viscosity, plasma viscosity and reduced viscosity) and TCD ( LVA, RVA, BA and PI) in the two groups were significantly improved, and the treatment group showed more significant improvement(P<0. 05). Conclusion:Vinpocetine combined with Danhong injections in the treatment of posterior cir-culation ischemia syndrome has significant effect in the effective improvement of blood rheology and hemodynamics, which is worthy of clinical promotion and application.

Influencing factors of vertebrobasilar dolichoectasia and hemodynamics changes in these patients / 中华神经医学杂志

Objective To study the related influencing factors involving in vertebrobasilar dolichoectasia (VBD) and changing characteristics of hemodynamics of VBD. Methods Outpatients and inpatients with posterior circulation ischemia (PCI) underwent brain MRA from June 2008 to September 2009 were chosen; 116 patients met the standard of VBD were selected as VBD group and other 130 patients without VBD were as control group. The univariate analysis and multiple factor analysis were applied to study the correlation of hypertension,smoking,diabetes,low-density lipoprotein (LDL) and intracranial vascular variation with VBD.Transcranial Doppler (TCD) ultrasound and digital subtraction angiography (DSA) were applied to observe the hemodynamic changes and arteriosclerosis of these patients.Results Univariate analysis indicated that statistical significance on intracranial vascular variation,hypertension and smoking was noted between the VBD group and the control group (x2=13.530,P=0.000; x2=8.539,P=0.003; x2=3.959,P=0.047),while no statistical significance in diabetes and LDL was obtained between the 2 groups (x2=0.451,P=0.519; x2=0.220,P=0.881).Multiple factors analysis showed that VBD could be obviously related to intracranial vascular variation (OR=21.732, 95％CI:3.02-5.94),hypertension (OR=5.173,95％CI:1.23-3.05) and smoking (OR=3.145,95％CI:1.86-4.85).According to TCD,peak velocity (Vp),mean velocity (Vm) in the VBD group were significantly lower than those in the control group,but pulsatility index (PI) and resistant index (RI) in the VBD group were statistically higher (P＜0.05).DSA showed that the blood flow length of the VBD group was obviously shorter than that of the control group in the same time with statistical significance (P＜0.05). Conclusion Vascular variation,smoking and hypertension are related to VBD; and VBD leads to slow blood flow and aggravated arteriosclerosis,which may result in high incidence of stroke.