Significance of Vertigo, Imbalance, and Other Minor Symptoms in Hyperacute Treatment of Posterior Circulation Stroke.

Background: This study aimed to determine the clinical significance of acute vestibular syndrome (AVS)/acute imbalance syndrome (AIS) in posterior circulation stroke (PCS) and how it should be addressed in the thrombolysis code. Methods: Our institution has recently changed its thrombolysis code from one that is generous to AVS/AIS to one that is exclusive. The subjects in this study were patients with PCS who presented before this transition (May 2016 to April 2018, period 1) and those who presented after (January 2019 to December 2020, period 2) with an onset-to-door time of 4.5 h. Hyperacute stroke treatment was compared between the two periods. The clinical significance of AVS/AIS was evaluated by dichotomizing the patients' clinical severity to minor or major deficits, then evaluating the significance of AVS/AIS in each group. Presenting symptoms of decreased mental alertness, hemiparesis, aphasia (anarthria), or hemianopsia were considered major PCS symptoms, and patients who did not present with these symptoms were considered minor PCS. Results: In total, 114 patients presented in period 1 and 114 in period 2. Although the code activation rate was significantly lower in period 2 (72.8% vs. 59.7%), p = 0.04, there were no between-group differences in functional outcomes (mRS score at 3 months; 1 [0-3] vs. 0 [0-3], p = 0.18). In 77 patients with PCS and AVS/AIS, the difference in code activation rate was not significant according to changes in thrombolysis code. In minor PCS, AVS/AIS was associated with lower NIHSS scores, lower early neurological deterioration rates, and favorable outcomes. In major PCS, while AVS/AIS was not associated with outcomes, the majority of cases were prodromal AVS/AIS which simple vertigo and imbalance symptoms were followed by a major PCS symptom. Conclusions: This study failed to show differences in outcome in patients with PCS according to how AVS/AIS is addressed in the stroke thrombolysis code. In patients with minor PCS, AVS/AIS was associated with a benign clinical course. Prompt identification of prodromal AVS/AIS is essential.

Posterior circulation ischemic stroke not involving the brainstem is associated with cardiovascular autonomic dysfunction.

BACKGROUND AND PURPOSE: Ischemic stroke may induce cardiovascular autonomic dysfunction, but most previous studies have included patients with anterior circulation ischemic stroke or brainstem stroke. It remains unclear whether posterior circulation ischemic stroke (PCIS) without brainstem involvement also compromises cardiovascular autonomic modulation (CAM). Therefore, we aimed to assess CAM in PCIS patients with and without brainstem involvement. METHODS: In four subgroups of 61 PCIS patients (14 occipital lobe, 16 thalamic, 12 cerebellar, and 19 brainstem strokes) and 30 healthy controls, we recorded RR intervals (RRIs), systolic (SBP) and diastolic blood pressure (DBP), and respiration at supine rest during the first week after stroke onset. We calculated parameters reflecting total CAM (RRI-standard deviation [RRI-SD], RRI-total powers), predominantly sympathetic CAM (RRI-low-frequency [LF] powers and SBP-LF powers] and parasympathetic CAM (root mean square of successive RRI differences [RMSSD], RRI-high-frequency [HF] powers), sympathetic-parasympathetic balance (RRI-LF/HF ratios), and baroreflex sensitivity (BRS). Values were compared among the four PCIS groups and controls using one-way ANOVA Kruskal-Wallis tests, with post-hoc analyses. Significance was assumed for p < 0.05. RESULTS: In each PCIS subgroup, values for RRI, RRI-SD, RMSSD, RRI-HF powers, and BRS were significantly lower, while SBP-LF powers were higher than in the controls. Only in patients with occipital lobe stroke were RRI-LF/HF ratios significantly higher than in controls. Otherwise, autonomic variables did not differ among the four PCIS subgroups. CONCLUSIONS: During the first week after stroke onset, our PCIS patients with occipital lobe, thalamic, cerebellar, or brainstem strokes all had reduced cardiovagal modulation, compromised baroreflex, and increased peripheral sympathetic modulation. The RRI-LF/HF ratios suggest that sympathetic predominance is slightly more prominent after occipital lobe stroke. PCIS may trigger cardiovascular autonomic dysfunction even without brainstem involvement.

Migraine-Associated Common Genetic Variants Confer Greater Risk of Posterior vs. Anterior Circulation Ischemic Stroke☆.

OBJECTIVE: To examine potential genetic relationships between migraine and the two distinct phenotypes posterior circulation ischemic stroke (PCiS) and anterior circulation ischemic stroke (ACiS), we generated migraine polygenic risk scores (PRSs) and compared these between PCiS and ACiS, and separately vs. non-stroke control subjects. METHODS: Acute ischemic stroke cases were classified as PCiS or ACiS based on lesion location on diffusion-weighted MRI. Exclusion criteria were lesions in both vascular territories or uncertain territory; supratentorial PCiS with ipsilateral fetal posterior cerebral artery; and cases with atrial fibrillation. We generated migraine PRS for three migraine phenotypes (any migraine; migraine without aura; migraine with aura) using publicly available GWAS data and compared mean PRSs separately for PCiS and ACiS vs. non-stroke control subjects, and between each stroke phenotype. RESULTS: Our primary analyses included 464 PCiS and 1079 ACiS patients with genetic European ancestry. Compared to non-stroke control subjects (n=15396), PRSs of any migraine were associated with increased risk of PCiS (p=0.01-0.03) and decreased risk of ACiS (p=0.010-0.039). Migraine without aura PRSs were significantly associated with PCiS (p=0.008-0.028), but not with ACiS. When comparing PCiS vs. ACiS directly, migraine PRSs were higher in PCiS vs. ACiS for any migraine (p=0.001-0.010) and migraine without aura (p=0.032-0.048). Migraine with aura PRS did not show a differential association in our analyses. CONCLUSIONS: Our results suggest a stronger genetic overlap between unspecified migraine and migraine without aura with PCiS compared to ACiS. Possible shared mechanisms include dysregulation of cerebral vessel endothelial function.

Novel and Efficient Quantitative Posterior-Circulation-Structure-Based Scale via Noncontrast CT to Predict Ischemic Stroke Prognosis: A Retrospective Study.

(1) Background: Posterior circulation ischemic stroke has high mortality and disability rates and requires an early prediction prognosis to provide the basis for an interventional approach. Current quantitative measures are only able to accurately assess the prognosis of patients using magnetic resonance imaging (MRI). However, it is difficult to obtain MRI images in critically urgent cases. Therefore, the development of a noncontrast CT-based rapid-assist tool is needed to enhance the value of the clinical application. (2) Objective: This study aimed to develop an auxiliary-annotating noncontrast CT-efficient tool, which is based on a deep learning model, to provide a quantitative scale and the prognosis of posterior circulation ischemic stroke patients. (3) Methods: A total of 31 patients with posterior circulation ischemic stroke, diagnosed in the stroke registry at the Tri-Service General Hospital from November 2019 to July 2020, were included in the study, with a total of 578 CT images collected from noncontrast CT and MRI that were ≤ 3 days apart. A 5-fold cross validation was used to develop an image segmentation model to identify nine posterior circulation structures, and intersection over union (IoU) was used to assess the ability of the model to identify each structure. A quantitative score was integrated to assess the importance of the proportion of ischemic lesions in each posterior circulation structure, and the ROC curve was compared with the semiquantitative score for prognostic power. The prognoses of the patients were defined into two groups of 18 patients. An mRS score of 0-2 at discharge was defined as a good prognosis, while an mRS score of 3-6 was deemed to be a poor prognosis. (4) Results: The performance of the image segmentation model for identifying the nine posterior circulation structures in noncontrast CT images was evaluated. The IoU of the left cerebellum was 0.78, the IoU of the right cerebellum was 0.79, the IoU of the left occipital lobe was 0.74, the IoU of the right occipital lobe was 0.68, the IoU of the left thalamus was 0.73, the IoU of the right thalamus was 0.75, the IoU of the medulla oblongata was 0.82, and the IoU of the midbrain was 0.83. The prognostic AUC of posterior circulation patients predicted using a quantitative integrated score was 0.74, which was significantly higher than that of the pc-ASPECTS (AUC = 0.63, p = 0.035), with a sensitivity of 0.67 and a specificity of 0.72. (5) Conclusions: In this study, a deep learning model was used to develop a noncontrast CT-based quantitative integrated score tool, which is an effective tool for clinicians to assess the prognosis of posterior circulation ischemic stroke.

The Clinical Research Progress of Vertebral Artery Dominance and Posterior Circulation Ischemic Stroke.

BACKGROUND: The diameters of the vertebral arteries on both sides are usually asymmetrical. Vertebral artery dominance (VAD) and congenital vertebral artery dysplasia are derived from the asymmetry of the vertebral artery diameters on both sides. They are usually regarded as normal congenital vascular variations and have no practical clinical significance. SUMMARY: Recently, several clinical studies have found that VAD is a risk factor for posterior circulation ischemic stroke (PCIS). The existence of VAD is clinically significant for the occurrence of PCIS, and it is recognized by an increasing number of clinicians. KEY MESSAGES: This article reviews the frequency and evaluation methods of VAD, its correlation with PCIS, and its mechanism.

Impairment of attention network function in posterior circulation ischemia-evidence from the Attention Network Test.

Objective: This study aimed to investigate the effect of posterior circulation ischemia (PCI) on attention network function and to determine whether PCI is holistic or selective attention network deficit and which attention network is affected. Methods: Thirty-six PCI patients aged 30 to 75 were assessed using the Attention Network Test and the Mini-Mental State Examination (MMSE). There were no significant differences in age, sex, and education between PCI group and the control group (n = 32). All data were statistically analyzed by SPSS 23.0 software. Result: There were no significant difference in the MMSE scores between the two groups. Compared with the control group, the PCI group had significantly shorter response time for alerting and orienting network. The executive control network response time was significantly longer in PCI group than in the control group. The overall mean response time was also significantly longer in PCI group than in normal control group. There was no significant difference in mean accuracy between the two groups. Conclusion: The alerting, orienting, and executive control networks were significantly less efficient in PCI group than in the control group (P < 0.01). This indicates impaired attention network in PCI patients. Since transient nerve seizures caused by vertebrobasilar ischemia may precede posterior circulation stroke, early assessment of cognitive function in patients with PCI is particularly important, and ANT is an excellent tool for this assessment.

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 dissection caused by atlantoaxial dislocation: a case report and review of literature.

BACKGROUND: Atlantoaxial dislocation (AAD) is the most common craniovertebral junction malformation (CVJm) which are anomalies of the bones and soft tissues surrounding the foramen magnum. It usually leads to neurologic abnormalities because of instability of this mobile area. But vertebral artery dissection (VAD) caused by AAD is uncommon. CASE REPORT: We report a 15-year-old boy who presented with acute onset of bilateral VAD leading to posterior circulation ischemic stroke (PCIS). Computed tomography angiography (CTA) indicated dissection and occlusion of bilateral intracranial vertebral arteries and AAD with os odontoideum. After antithrombotic treatment for 3 months, the patient got complete revascularization and received posterior C1-C2 fusion. DISCUSSION: There have only been tens of cases of PCIS caused by CVJm. We reviewed these relevant literatures and suggested that more attention should be paid to vascular impairment for patients with CVJm.

[Room tilt illusion: a chief complaint need to be alert in otology clinic].

Objective:This study aims to investigated the clinical significance of room tilt illusion（RTI） in screening for central vertigo in otology clinic. Method:A retrospective study of 8 RTI cases out of 656 patients with dizziness and/or vertigo. The characteristics of the symptoms, signs, physical examination, and other examinations of RTI patients were analyzed. Result:①Patients with RTI complaints accounted for 1.2% of all patients with dizziness and/or vertigo in the same period. Of all 8 patients, 2 were with acute vestibular syndrome, 5 were with episodic vestibular syndrome, and one had no dizziness and/or vertigo attack. ②Two was diagnosed with acute cerebellar infarction, and 3 was diagnosed with posterior circulation transient ischemic attacks, 2 were diagnosed with definite vestibular migraine, and one was unable to identify the cause. ③All 8 patients had a sensation of environment tilting, which was episodic（single or repeated）, transient（seconds to minutes）, in the coronal plane, and with tilt angle 30-180°. ④Seven patients had dizziness and/or vertigo for minutes to hours after a transient RTI, and one patient had no other symptoms after RTI. ⑤All patients had no decrease in vHIT gain, 6 patients had abnormal oculomotor function, and one patient had mild horizontal semicircular canal paresis. Conclusion:Patients with RTI complaints mainly had central dizziness and vertigo diseases, and once are found in otology clinic, should be alert to the possibility of suffering from central diseases.

Risk of posterior circulation stroke in patients with cervical spondylosis: A nationwide, population-based study.

BACKGROUND AND AIMS: Cervical spondylosis (CS) is reported to be associated with vertebrobasilar insufficiency. However, few cohort studies have investigated the association between CS and posterior circulation ischemic stroke. METHODS: The study cohort comprised 27,990 patients aged ≥18 years with a first diagnosis of CS. The controls consisted of patients with propensity score matched for age, sex, and comorbidities at a ratio of 1:1. We investigated the relationships of CS with ischemic stroke and all-cause mortality. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). The average follow-up duration was 6.13 (SD = 3.18) and 6.07 (SD = 3.19) years in the CS and non-CS cohorts, respectively. RESULTS: The mean age of CS patients and non-CS patients was 54.9 ±â€¯13.4 and 55.1 ±â€¯14.9 years. Fifty-eight point five percent of CS patients and 59.2% of non-CS patients were women. CS patients were 1.46 folds more likely to develop a posterior circulation ischemic stroke (95% CI, 1.23-1.72) than non-CS patients. CS patients with myelopathy exhibited a 1.50-fold risk (95% CI, 1.21-1.86) of posterior circulation ischemic stroke compared with non-CS patients; CS patients without myelopathy were at a 1.43-fold risk (95% CI, 1.18-1.73) of posterior ischemic stroke compared with non-CS patients. The risk of posterior ischemic stroke was non-significant between non-CS patients and CS patients who had received spinal anterior decompression (adjusted HR, 1.66; 95% CI, 0.78-3.52), while receiving posterior decompression was associated with a 4.23-fold risk of posterior ischemic stroke (95% CI, 1.05-17.0). CONCLUSIONS: This population-based study showed that CS is associated with an increased risk of posterior circulation ischemic stroke. Surgical posterior decompression was associated with the highest risk of posterior ischemic stroke.

A Case of Posterior Circulation Ischemic Stroke Caused by Heparin-Induced Thrombocytopenia after Detaining Hepatic Arterial Infusion Catheter.

In Japan, hepatic arterial infusion chemotherapy (HAIC) using reservoir system is recommended for patients with hepatocellular carcinoma (HCC) whose hepatic spare ability is favorable. Arterial infusion catheter is commonly detained in hepatic artery via femoral or brachial artery. In our hospital, catheter is often inserted by puncturing the left subclavian or brachial artery considering the patient's activities of daily living (ADL) during long-term detaining. However, it rarely causes posterior circulation ischemic stroke because of the left vertebral artery branches on the path of catheter. We herein report a case of posterior circulation ischemic stroke caused by heparin-induced thrombosis (HIT) after detaining hepatic arterial infusion catheter. A 63-year-old man who is under HAIC treatment for HCC was introduced to the department of neurological surgery because of vertigo and vomiting. Magnetic resonance imaging revealed sporadic fresh cerebral infarction in the bilateral cerebellar hemisphere. Carotid ultrasonography detected a floating thrombus around the part of the left vertebral subclavian artery bifurcation. Detained catheter was removed and continuous heparin administration was started immediately. However, thrombocytopenia occurred 5 days after the injection. Because 4T's score was 6 points, HIT was strongly suspected. We stopped heparin injection immediately and observed the patient's physical status strictly. After that, platelet value improved naturally. At the late date, antibodies specific for platelet factor 4/heparin complexes were positive and he was diagnosed with HIT.

Effects of Vestibular Function Rehabilitation Combined with Proprioceptive Sense Training on Senile Posterior Circulation Ischemic Vertigo / 中国康复理论与实践

@# Objective To observe the effects of vestibular function training and proprioception training on vertigo and balance function after postoperative circulatory ischemia under the visual participation. Methods From June, 2016 to May, 2018, 72 patients with posterior circulation ischemic vertigo aged more than 60 were randomly divided into proprioception group (n = 24), vestibular group (n = 24) and comprehensive group (n = 24). All the patients received routine medicine and rehabilitation training. Moreover, the proprioception group accepted proprioception training, the vestibular group accepted vestibular function training, and the comprehensive group accepted both proprioception training and vestibular function training. They were assessed with Dizziness Assessment Rating Scale (DARS), Dizziness Handicap Inventory (DHI) and Berg Balance Scale (BBS) before and after four weeks of treatment, while the mean velocity (Vm) of blood flow in the basilar artery was measured with transcranial Doppler, and the stability index (ST) was measured with Tetrax. Results The scores of DARS, DHI and BBS, and Vm and ST improved in all the groups after treatment (t > 57.825, P < 0.001). However, the scores of DHI and BBS, and ST improved more in the comprehensive group than in the proprioception group and the vestibular training group (P < 0.05), Vm and score of DARS improved more in the vestibular group and the comprehensive group than in the proprioception group (P < 0.05). Conclusion With the participation of the vision, vestibular function training combined with proprioception training can further alleviate vertigo caused by postoperative circulatory ischemia, and improve balance and quality of life.

Greater periventricular white matter hyperintensity severity in basilar artery branch atheromatous disease.

BACKGROUND: Basilar artery branch atheromatous disease (BABAD), in which basilar artery atheroma occludes penetrating arteries at their origin, is a common etiology of posterior circulation stroke (PCS). It is currently unknown whether white matter hyperintensity(WMH), a marker of small vessel disease(SVD), is associated with BABAD. METHODS: The present study analyzed data from patients with PCS who were enrolled in the Taipei Veterans General Hospital Stroke Registry between January 1, 2010 and February 28, 2014. WMH severity was rated using the Scheltens scale. We used multivariate analyses to: (1) compare the severity of WMH between patients with BABAD, patients with large-artery > 50% atherosclerotic stenosis-related PCS(LAA), and non-stroke subjects(NS); and (2) evaluate the relationship between WMH severity and the 3-month prognosis of patients with BABAD. RESULTS: The study pool included 151 BABAD, 97 LAA, and 78 non-stroke patients. Multivariate analyses adjusting for age, sex, and vascular risk factors showed that compared to patients with LAA [Odds ratio(OR) = 0.51, p = 0.037] and NS (OR = 0.40, p = 0.004), patients with BABAD (OR = 1) had greater WMH severity (score ≥ 50th percentile) in periventricular, but not subcortical, regions. Moreover, greater periventricular WMH severity predicted poor 3-month functional outcomes (modified Rankin Scale > 3) with an OR of 3.21 (p = 0.028) in BABAD patients. CONCLUSIONS: We are the first to show a significant association between WMH and BABAD that is independent of vascular risk factors and atherosclerotic large-artery disease. Our results suggest that small vessel abnormalities other than lipohyalinosis may be involved in BABAD pathophysiology. A future management strategy should include both large and small vessel protection.

Evaluation of recanalisation treatment on posterior circulation ischemic stroke by Solitaire device-A multicenter retrospective study.

OBJECTIVES: Posterior circulation ischemic stroke (PCIS), accounting for approximately 20% of total ischemic stroke, is a sever disease that associated with high rate of morbidity and mortality. Though the effectiveness of endovascular mechanical thrombectomy has been well demonstrated in many types of ischemic stroke, it is still unclear what the outcome is in posterior circulation ischemic stroke. METHODS AND MATERIALS: In current study, data was collected from 139 Chinese patients who received endovascular mechanical thrombectomy treatment with Solitaire device after acute posterior circulation ischemic stroke. We measured the mortality, symptomatic intracranial hemorrhage (SICH) and National Institutes of Health Stroke Scale (NIHSS) to evaluate the safety of endovascular mechanical thrombectomy. Meanwhile, the clinical outcome of endovascular mechanical thrombectomy was also evaluated based on recanalisation rate, HIHSS, and the modified Rankin Scale (mRS). RESULTS: Recanalisation was successful in 124 (89.3%) patients after surgery. Herniation was the second fatal stroke complication, out of the 6 patients suffered from herniation, 3 patients (50%) died during surgery and 2 (33%) died after surgery. As for other stroke complications such as pulmonary infection, 1 patient (4.3%) died during surgery and 1 patient (4.3%) died 3 days after surgery. CONCLUSION: Our findings indicate that endovascular mechanical treatment is a safe treatment which brings clear benefit to patients suffered from posterior circulation ischemic stroke, in both the recanalisation rate and functional outcomes.

Analysis of GUO Weifeng's Experience in Treating Posterior Circulation Ischemic Vertigo by Mothod of Nourishing the Kidney and Softening the Liver Yang / 浙江中医药大学学报

[Objective]To explore and analyze Professor GUO Weifeng's clinical experience in treating posterior circulation ischemic vertigo. [Methods] By learning with the teacher, collection of relevant information and medical records ,to expound Professor GUO Weifeng 's academic thoughts and clinical experience in posterior circulation ischemic vertigo, from aspects of etiology, pathogenesis, and syndrome differentiation and treatment variation, prescription medication, summarizing the characteristics of his prescriptions and ways of treatment as well as exemplifying them. [Results] Professor GUO Weifeng through many years of clinical practice proposes that the basic pathogenesis of this disease is liver with kidney deficiency and hyperactivity of liver-yang. Because of its more associated with obesity and high blood pressure, high blood lipids, diabetes, always mingle phlegm and stasis. The main treatment method is to nourish the Yin of liver-kidney, pacify liver and extinguish wind. Then, transform phlegm and disperse blood stasis. If pathogenic into collateral for a long time,we need using insect drug for treatment. Clinical treatment should be based on positive and evil of the partial ups and downs, the disease of both, flexible adjustment of medication, it is not limited by present method. [Conclusion] Professor GUO Weifeng 's clinical experience in treating posterior circulation ischemic vertigo is effective and worthy of wide application.