Vertebrobasilar Artery Insufficiency Research Articles

The clinical efficacy and safety of Ginkgo biloba in vertigo patients: A meta-analysis

ObjectiveWe detected the clinical efficacy and safety of Ginkgo biloba in vertigo patients through a meta-analysis method. MethodPubMed, Web of Science, Embase, Cochrane, EBSCO, CBM, CNKI, and Wanfang databases were searched for randomized controlled trials. Data about the clinical efficacy and safety of vertigo patients were collected. The Ginkgo biloba groups were pooled to compare with the control groups and obtain the pooled odds ratios and associated 95 % confidence interval. ResultsWe retrieved 25 randomized controlled studies enrolling 1209 patients. The addition of Ginkgo biloba improved vertigo in patients with vertebrobasilar artery insufficiency, cervical vertigo, and not-specific-disease vertigo but not in BPPV and Meniere’s disease. The incidence of adverse reactions such as headache, gastrointestinal discomfort, and skin rashes in the Ginkgo biloba group did not differ significantly from that of the control group. ConclusionThe addition of Ginkgo biloba had better clinical efficacy in patients with vertebrobasilar artery insufficiency, cervical vertigo, and not-specific-disease vertigo but not in BPPV and Meniere’s disease, and the Ginkgo biloba group had no significant differences in adverse reactions compared with the control group.

Changes in Vertebral Artery Blood Flow in Different Head Positions and Post–Cervical Manipulative Therapy

ObjectiveThe objective of this study was to investigate the hemodynamics of blood flow through the V3 region of the vertebral artery contralateral to the side manipulated during different rotary head positions and post–cervical spinal manipulation. MethodsThis quasi-experimental study was performed on 25 healthy, asymptomatic participants, both male and female, between 20 and 30 years of age. Each participant presented with a C0/C1 or C1/C2 cervical facet restriction (as determined by motion palpation). Participation was voluntary, and participants had no symptoms of vertebrobasilar artery insufficiency or contraindications to cervical spinal manipulation. Doppler ultrasound was used to measure vertebral artery blood flow (V3 region) hemodynamics, contralateral side of manipulation, as close to C1/C2 region as possible in 4 positions of cervical rotation (neutral, 45°, maximum, and post-manipulation neutral). Doppler ultrasound parameters included peak systolic flow velocity, end diastolic flow velocity, mean flow velocity, vessel diameter, and flow rate. The nonparametric Friedman test was used for analysis across each head and neck position, and post manipulation. ResultsNo clinical or statistically significant results (P > .05) were found for any of the hemodynamic parameters in any of the head positions. ConclusionsHemodynamic measurements of the V3 region of the vertebral artery do not show significant changes in the measured head positions or following manipulation of the upper cervical spine in patients without pre-existing risk factors.

Evolution of vestibular disorders in older adults: From young-old to middle-old to oldest-old.

This study investigated the evolution of vestibular disorders in dizzy older adults from young-old to middle-old to oldest-old individuals, which has been less examined in detail so far. A total of 3714 older patients with vertigo/dizziness in a university hospital were retrospectively reviewed and divided into three groups; namely, the young-old group aged 65-74 years (n = 2307), the middle-old group aged 75-84 years (n = 1176) and the oldest-old group aged ≥85 years (n = 231). All patients underwent an inner ear test battery comprising audiometry, caloric test, cervical and ocular vestibular-evoked myogenic potential tests, and foam posturography. The ratios between peripheral and central vestibular disorders ranged from the young-old (60:40%) and middle-old (36:64%) to the oldest-old (25:75%) groups. These results show a decreasing sequence in the prevalence of peripheral vestibular disorders (i.e. benign paroxysmal positional vertigo or Meniere's disease), and an increasing sequence in that of central vestibular disorders (i.e. vertebrobasilar artery insufficiency) from young-old to middle-old to oldest-old patients. Furthermore, the mean Romberg quotients (value from eyes closed divided by that from eyes open) of the sway area on the foam pad were 1.99 ± 0.93, 2.10 ± 1.06 and 2.62 ± 1.78 in the young-old, middle-old and oldest-old groups, respectively, showing a significant difference among them. Older patients with central vestibular disorders might be more prone to imbalance and falls than those with peripheral vestibular disorders, partly because patients in the latter group retain other reflex systems; that is, the visuomotor reflex to stabilize the gaze and maintain balance. Hence, adequate vision is important in maintaining balance for older adults with vertigo/dizziness. Geriatr Gerontol Int 2020; 20: 42-46.

Clinical research of Tongqiao-Huoxue decoction for the treatment of vertebrobasilar artery insufficiency vertigo with stasis orifice type

Objective To investigate the clinical application of Tongqiao-Huoxue decoction for the treatment of vertebrobasilar artery insufficiency vertigo with stasis orifice type. Methods According to the random table method, 93 vertebrobasilar artery insufficiency vertigo patients with stasis orifice type were divided into the control group (n=46) and the treatment group (n=47). The patients in the control group were treated with fluoguizine hydrochloride, while the patients in the treatment group were treated with Tongqiao-Huoxue decoction on the basis of control group. Two groups were treated for 4 weeks. The clinical total effective rate of two groups of patients after treatment was compared. The LVA mean blood flow velocity, RVA mean blood flow velocity, BA mean blood flow velocity, total blood viscosity, plasma viscosity, erythrocyte aggregation index, fibrinogen, TC, TG, LDL-C and HDL-C were detected respectively before and after treatment. In addition, the adverse reaction incidence of two groups of patients were observed. Results The total effective rate of treatment group was 93.6% (44/47), while the total effective rate of control group was 78.3% (36/46). The difference between two groups was statistically significant (χ2=4.559, P=0.033). After treatment,the LVA mean blood flow velocity (38.34 ± 3.72 cm/s vs. 29.73 ± 3.11 cm/s, t=12.096), RVA mean blood flow velocity (41.12 ± 4.05 cm/s vs. 34.11 ± 3.86 cm/s, t=8.541),BA mean blood flow velocity (48.92 ± 5.24 cm/s vs. 40.75 ± 4.63 cm/s, t=7.962), HDL-C (2.13 ± 0.64 mmol/L vs. 1.54 ± 0.53 mmol/L, t=4.836) of treatment group were significantly higher than the control group (P<0.05), while the total blood viscosity, plasma viscosity, erythrocyteaggregation index, fibrinogen, TC, TG, LDL-C of treatment group were significantly lower than the control group (t value were 5.457, 8.875, 3.661, 6.549, 3.838, 6.369, 5.201, all Ps<0.05). No serious adverse reactions occurred during the treatment of the two groups. Conclusions The clinical curative effect of Tongqiao-Huoxue decoction for the treatment of vertebrobasilar artery insufficiency vertigo with stasis orifice type is significantly, and it can increases blood flow to the brain, improve hemorheology and lipid levels. It has the high security of the forward curative effect. Key words: Vertigo; Vertebrobasilar insufficiency; Tongqiao-Huoxue decoction; Flunarizine hydrochloride capsules; Syndrome of static blood blocking orifices

Clinical medication characteristics of Shuxuening injection in treatment of cerebral infarction research based on registration

To understand the medication characteristics of Xingxue@Shuxuening solutions in the real world, multi-center, large-sample-size registration design method is adopted in this study. Between October 2012 and October 2015, hospitalized patients in 27 medical institutions who used Shuxuening and diagnosed as cerebral infarction were observed, including their general information, diagnosis information and medication information. Totally 9 473 cases of cerebral infarction were included, with old people as the majority, and males were slightly more men than females; they were complicated with coronary heart disease, vertebrobasilar artery insufficiency, transient brain ischemia and other cerebrovascular diseases; the medication duration was mostly within 14 days; the dosage was mainly 8-20 mL; 0.9%NS, 5%GS were the main solvent; commonly used drug combination was Ozagrel sodium injection, Shuxuetong injection, Alprostadil injection and other medicines for inhibiting platelet aggregation and blood vessel dilatation, and Cytidine diphosphate choline injection, Edaravone injection, Oxiracetam injection and other brain protective agents. The above results indicate that the clinical medication characteristics of Shuxuening are basically consistent with the package insert, except for the solvent; combined medicine is dominated by antiplatelet drugs; for old patients, various anticoagulant drugs shall selected according to their specific conditions to avoid the occurrence of adverse reactions.

Study on Cerebral Blood Flow Regulatory Features of Acupuncture Stimulation at Various Acupoints

Abstract Background: Acupuncture therapy is widely used for treating cerebrovascular diseases, including chronic cerebral artery insufficiency, poststroke, and vertebrobasilar artery insufficiency (VBI). To improve the effect of acupuncture for treating cerebral vascular diseases, it is necessary to clarify the effect of the individual acupoints on the cerebral hemodynamic indices and prescribe the acupoints according to their functional features. Objective: The goal of this research was to observe the influence of acupuncture stimulation at some acupoints of the Gallbladder and Bladder Meridians on cerebral hemodynamic indices. Materials and Methods: For this study, 249 patients with cerebrovascular diseases, including VBI, poststroke, and chronic cerebral artery insufficiency were observed. All participants were outpatients in the Pyongyang Medical College Hospital of Kim Il Sung University, in Pyongyang City, of the Democratic People's Republic of Korea, from January of 2012 to October of 2014. Various...

Relevance of the Pharmacokinetic and Pharmacodynamic Profiles of Puerariae lobatae Radix to Aggregation of Multi-Component Molecules in Aqueous Decoctions.

The complexity of traditional Chinese medicines (TCMs) is related to their multi-component system. TCM aqueous decoction is a common clinical oral formulation. Between molecules in solution, there exist intermolecular strong interactions to form chemical bonds or weak non-bonding interactions such as hydrogen bonds and Van der Waals forces, which hold molecules together to form “molecular aggregates”. Taking the TCM Puerariae lobatae Radix (Gegen) as an example, we explored four Gegen decoctions of different concentration of 0.019, 0.038, 0.075, and 0.30 g/mL, named G-1, G-2, G-3, and G-4. In order of molecular aggregate size (diameter) the four kinds of solution were ranked G-1 < G-2 < G-3 < G-4 by Flow Cell 200S IPAC image analysis. A rabbit vertebrobasilar artery insufficiency (VBI) model was set up and they were given Gegen decoction (GGD) at a clinical dosage of 0.82 g/kg (achieved by adjusting the gastric perfusion volume depending on the concentration). The HPLC fingerprint of rabbit plasma showed that the chemical component absorption into blood in order of peak area values was G-1 < G-2 > G-3 > G-4. Puerarin and daidzin are the major constituents of Gegen, and the pharmacokinetics of G-1 and G-2 puerarin conformed with the two compartment open model, while for G-3 and G-4, they conformed to a one compartment open model. For all four GGDs the pharmacokinetics of daidzin complied with a one compartment open model. FQ-PCR assays of rabbits’ vertebrobasilar arterial tissue were performed to determine the pharmacodynamic profiles of the four GGDs. GGD markedly lowered the level of AT1R mRNA, while the AT2R mRNA level was increased significantly vs. the VBI model, and G-2 was the most effective. In theory the dosage was equal to the blood drug concentration and should be consistent; however, the formation of molecular aggregates affects drug absorption and metabolism, and therefore influences drugs’ effects. Our data provided references for the rational use of Chinese medicines in the clinic, such as the best oral preparation and decoction concentration.

A cross-sectional postal survey of musculoskeletal physiotherapists’ current practice of cervical pain assessment in relation to vertebrobasilar artery insufficiency, attitudes toward guidelines, and manual therapy practice

AbstractPurposeTo survey the current practice of cervical spine pain assessment in relation to vertebrobasilar artery insufficiency (VBI), attitudes toward guidelines, and the practice of achieving informed consent in advance of planned orthopaedic manual therapy interventions.MethodA self-administered postal survey was validated and sent to 325 physiotherapists working in the National Health Service (NHS) and private musculoskeletal practices in the Dorset and Hampshire region.ResultsThe response rate was 53% from NHS physiotherapists and 20% from private practice, overall 34% (n = 111). Compliance rates with published guidelines were 50.4%; the sample holds them in neutral opinion (51.4%), and also holds cervical manipulation in neutral opinion (n = 50; 45.5%). Of these, 30.4% of respondents use cervical manipulation; a practice more closely associated with male practitioners (Φ = 0.35 P < 0.001), most use non-manipulative techniques such as manual traction (86.3%) or mobilizations (96.1%) with exercise...

Clinical observation onthe treatment of 68 cases of insufficient blood supply of basilar artery with needle-knifetherapy

：Objective To evaluateclinical curative effect of debonding debridement trigonum submentale with needle-knife onvertebro-basilar artery insufficiency (VBI). Methods 131 cases of VBI sufferers wererandomly recruited into a control group (63 cases) and a treatment group (68 cases). Thetreatment group was treated by debonding debridement trigonum submentale withneedle-knife; while the control group was treated with puerarin intravenous injection.Observed the changes of clinical symptoms before and after the treatment and examinechanges of average of blood flowing speed in left vertebral artery, right vertebralartery, and basilar artery by TCD. Results The total effective rate was 89.71% and 85.71%in the treatment group and the control group respectively. Blood flowing speed of the leftvertebral artery, right vertebral artery,and basilar artery average showed remarkablechange (P＜0.01) after the treatment in the treatment group,, whose effectswere better than the control group (P＜0.05). Conclusion Debonding debridement trigonumsubmentale with needle-knife has remarkable curative effects on VBI. Key words: C-shaped Arm X-ray; Vertebro-basilar arteryinsufficiency; Needle-knife; Trigonum submentale

Subclavian artery stenosis causing transient bilateral brachial diplegia: an unusual cause of anterior spinal artery syndrome

The author report a case of a 74-year-old man who had presented with transient bilateral brachial diplegia. Investigations led to the diagnosis and treatment of subclavian artery stenosis. There are no known published cases of subclavian artery stenosis associated with transient bilateral arm weakness, and the authors believe that a steal phenomenon leading to vertebrobasilar artery insufficiency and subsequent anterior spinal artery insufficiency may have caused these symptoms, which resolved after correction of the patient's stenosis.

Vertebrobasilar Artery Insufficiency and Electroencephalogram

This is a renewed diagnostic approach to vertebrobasilar artery insufficiency (VBI)--a condition which stood in the focus of this author's interest several decades ago. The time for a revisitation has come. The EEG findings consist mainly of generally reduced voltage output and enhanced photic driving response. There is also some theta activity over anterior temporal and midtemporal region, but this finding is common in the early stage of all cerebrovascular disorders. Dysfunction of the pontine portion of the ascending reticular formation might be the cause of the lowered voltage output. The enhanced photic driving might be due to very light hypoxia of the visual cortex.

Nitrogen monoxide vector of ultrasonic atomizing inhalation improves vertebro-basilar artery insufficiency: Hemodynamic changes are detected by transcranial Doppler test

Background Latest researches at home and abroad indicate that glycerol trinitrate plays its function because it can metabolize into nitrogen monoxide (NO) in vivo. Objective To study the therapeutic effects of NO vector of ultrasonic atomizing inhalation on vertebro-basilar artery insufficiency (VBI) through transcranial Doppler (TCD) detection and serum NO content and indirect effect of TCD on cerebral blood flow changes. Design Randomized grouping and controlled clinical study. Setting Department of Neurology, the Fourth People's Hospital of Jinan. Participants A total of 130 patients who were diagnosed as VBI were selected from Department of Neurology, the Fourth People's Hospital of Jinan from December 2001 to December 2005. The involved inpatients were checked by CT and MRI, and met the VBI diagnostic standard enacted by the Fourth National Academic Meeting of Cerebrovascular Disease in 1995. All patients and their relatives provided the confirmed consent. They were randomly divided into low-dose treatment group ( n = 60), high-lose treatment group ( n = 30) and control group ( n = 40). Methods Patients in the low-dose and high-dose treatment groups were given ultrasonic atomizing inhalation of 3 mg and 5 mg glycerol trinitrate, respectively, for 20 minutes, once a day. In addition, ligustrazine and energy mixture were used once a day for three days in a course. Cases in the control group were only given ligustrazine and energy mixture. All selected cases accepted TCD, blood NO content was checked at the time of beginning, after the first time and after a period of treatment. ccording to the TCD test, VBI patients were divided into two groups (high-low flow velocity). The vertebral artery (VA) and basal artery (BA) of left or right sides were detected by 2 Hz detector via occipital window. Main outcome measures ▪ Blood flow velocity of systolic phase, blood flow velocity of diastole phase and vascular resistance in left and right VA and BA detected by using TCD before treatment, after treatment for one course; ▪ content of serum NO indirectly measured by using nitric acid disoxidation technique. Results All 130 VBI patients were involved in the final analysis. ▪ Changes of hemodynamic indexes: Systolic phase of VA and diastole phase of BA were higher in low-dose treatment group than that in the control group after first treatment, and there was significant difference ( P < 0.05); meanwhile, systolic phase and diastole phase of VA and systolic phase of BA were also higher in treatment group than that in the control group after one course ( P < 0.05). However, both systolic phase and diastole phase of VA and BA were lower in high-dose treatment group than that in the control group after first treatment and one course, and there was significant difference ( P < 0.05). ▪ Content of serum NO: After first treatment, there was no significant difference between low-dose treatment group and high-dose treatment group ( P > 0.05); but both groups were higher than control group, and there was significant difference ( P < 0.05, 0.01). Conclusion NO vector of ultrasonic atomizing inhalation can improve VBI so as to improve cerebral blood-supply state.

Application of Transcranial Doppler ultrasonography in the diagnosis of Meniere disease

目的 探讨经颅多普勒超声(TCD)在梅尼埃病与脑血管性眩晕鉴别诊断中的应用价值.方法利用TCD探查53例临床初步诊断为梅尼埃病的53例病人眩晕缓解期颈内动脉系统和椎-基底动脉系统血流情况.结果53例患者中,椎-基底动脉系统血液流速及血管搏动指数异常,提示血管腔狭窄或闭塞、血管壁弹性和顺应性降低者16例;未发现颈内动脉系统血流情况异常者.结论TCD能对椎-基底动脉系统大血管的血流动力学及血管情况进行客观评价,可作为诊断梅尼埃病的常规检查应用于临床,以鉴别梅尼埃病与椎基底动脉供血不足所致的眩晕。

Extracranial vertebral artery stent placement: in-hospital and follow-up results.

The authors summarize their experience with stent deployment in the treatment of vertebrobasilar artery (VBA) insufficiency. This is an underdiagnosed condition, and the incidence of significant vertebral artery (VA) stenosis has been underappreciated. Medical therapy has been the mainstay of treatment because of the high rate of morbidity associated with surgical correction of VA stenosis. Recently, some authors have reported acceptable results with the use of percutaneous transluminal angioplasty, but this technique has significant weaknesses such as elastic recoil and problems in achieving safe treatment of dissections. The authors investigated the feasibility, safety, and outcome of VA stent placement in 50 patients in whom 55 vessels were treated using stents. Technical success was achieved in 54 (98%) of 55 vessels, with no procedure-related complications. However, one patient (2%) died of nonneurological causes, and one (2%) suffered a stroke that occurred within the 30-day postprocedural period and was related to a complicated coronary intervention. Clinical follow-up review performed at a mean of 25 +/- 10 months revealed two patients (4%) with recurrence of VBA symptoms. Six-month angiographic follow up was completed in 90% of eligible patients, with a 10% incidence of restenosis as defined by greater than 50% luminal narrowing. Vertebral artery stent placement is feasible in patients who have significant VA stenosis, with predictably good angiographically demonstrated and clinical results. The 6-month angiographically confirmed restenosis rate appears to be low, as does the clinical recurrence rate. This technique solves the problems of elastic recoil and the treatment of angioplasty-induced dissections. Further prospective comparison with medical preventive strategies is warranted.

Assessment of vertebrobasilar artery insufficiency: a clinical audit and literature review.

As cerebrovascular accidents are now increasingly documented in the literature and represent perhaps the most serious side effect of chiropractic upper cervical manipulation, this study was designed to audit the risk assessment process in patients prior to manipulation in a group chiropractic practice. A questionnaire was devised to evaluate the performance of provocational tests and the recording of risk factors. It also examined the procedures carried out in the small numbers of patients who tested positive to vertebrobasilar insufficiency provocation. The audit was carried out in two cycles three months apart. Weaknesses in clinical procedure were identified following the first round audit, and assessment procedures modified in line with recommendations from reviewing the available literature. Improvements were generally evident in the performance of provocation tests, but practitioner recording of historical risk factors at initial consulation, although improved, remained poor. The study is accompanied by a literature review designed to establish the evidence underlying the use of provocational tests, and to consider whether these tests should become mandatory in any forthcoming guidelines for chiropractic practice in this country. After reviewing the evidence available in the biomedical literature, it was apparent that there maybe alterations in blood flow at the upper cervical segment during rotation and extension, but that the vertebral artery is not completely occluded and that the test is therefore not conclusive in identifying patients at risk. The astute practitioner can strengthen their position in this respect by careful assessment of risk factors in the case history, avoiding extremes of rotation and extension and by refraining from repeated rotary manipulations in patients who have experienced post-manipulation dizziness. However, it appears that cerebrovascular accidents can occur even where all these precautions have been taken, that provocation tests are an unreliable indicator and should be omitted from the pre-manipulative recommendations of any future guidelines.

MR angiography in cases with Vertebrobasilar Artery Insufficiency

MR angiography in cases with Vertebrobasilar Artery Insufficiency

Isolated Visual Symptoms in an Older Woman

To the Editor. —In the recent Questions and Answers 1 discussion of a 63-year-old woman with vague visual alterations, tinnitus, and hypertension, Dr Mohr provides a useful summary and concludes that ophthalmologic cause seems most likely. Dr Goodwin also ascribes accommodation difficulties and raises the possibility of drug-induced symptoms. At first glance, the patient's symptoms appear isolated to the ophthalmologic area, but I believe that both have missed the diagnosis. This woman suffers from a common neurologic condition known as vertebrobasilar artery insufficiency (VBAI). Because posterior circulation ischemic symptoms may be vague and mimic other conditions, the diagnosis of VBAI is often missed. It is important to recognize that tinnitus, hypertension, and the age of the patient are important clues. For example, in older patients, tinnitus may be an early warning signal of ischemia in the anterior-inferior cerebellar artery. Selective involvement of the cochlear artery may be specifically responsible

MULTIVARIATE ANALYSIS OF EVERYDAY HANDICAP OF PATIENTS WITH DIZZINESS

A preliminary questionnaire consisting of 30 questions was developed to evaluate handicaps in everyday life for 105 patients with dizziness. Factor analysis divided the questions into 5 principal factors of handicap due to dizziness: 1) disturbance of social activity, 2) body motion precipitating dizziness, 3) limitation of physical activity, 4) emotional disturbance, and 5) disturbance of interpersonal communications. The score of each factor was calculated as the sum of the scores of three principal questions in the corresponding factor. There was no contribution of clinical diagnosis, patient's age or gender, or duration of the disease to the score of each factor. Thus, it is concluded that the reorganized questionnaire which consists of three principal questions in 5 factors can be used for evaluating dizziness handicaps in everyday life. The score of the emotional factor in patients with Meniere's disease was higher than that for other vestibular disease. The score of the body motion factor in patients with vestibular neuronitis was higher than that for vertebro-basilar artery insufficiency. Thus, the re-organized questionnaire can also be used for evaluating the contribution of each factor to dizziness handicaps in everyday life.

信大方式家庭内平衡訓練

We devised a series of tasks as therapy for some types of vertigo. The task are as follows: 1) keeping the head in a position that elicits vertigo,2) head movements beginning in the sitting position,3) a short rest,4) body trunk movements,5) clockwise and counterclockwise body rotations while standing with eyes closed,7) walking forwards and backwards with eyes closed.We obtained favo r able results with this therapy in one of ten patients with Meniere's disease, all seven patients with benign paroxysmal positional vertigo and six of ten patients with vertebro-basilar artery insufficiency. Our home therapy is recommended for all patients with benign paroxysmal positional vertigo and selected patients with vertebrobasilar artery insufficiency.

Compressed Spectral Array EEG Monitoring during Coronary Bypass Surgery in a Patient with Vertebrobasilar Artery Insufficiency

Compressed Spectral Array EEG Monitoring during Coronary Bypass Surgery in a Patient with Vertebrobasilar Artery Insufficiency