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Huang F, Wang Z, Zhang Z, Liu X, Liang Y, Qian J, Tu J, Tang X, Zhang C, Fang B. Comprehensive evaluation of the mechanism of Banxia Baizhu Tianma Decoction in ameliorating posterior circulation ischemia vertigo based on integrating fecal short-chain fatty acids and 16S rRNA sequencing. J Pharm Biomed Anal 2024; 247:116195. [PMID: 38810328 DOI: 10.1016/j.jpba.2024.116195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/21/2024] [Accepted: 05/01/2024] [Indexed: 05/31/2024]
Abstract
Posterior circulation ischemia vertigo (PCIV) is vertebrobasilar insufficiency resulting in vertigo. Banxia Baizhu Tianma Decoction (BBTD) is broadly applied to treat PCIV in China, but its efficacy and detailed mechanism remains unclear. Therefore, this study aims to investigate the effects of BBTD on PCIV, and identify important gut microbiota and its derived short-chain fatty acid (SCFA) changes and the detailed mechanism through 16 S rRNA sequencing with SCFAs profiling. In this study, the model of PCIV was established by surgical ligation of the right subclavian artery (RSCA) and right common carotid artery (RCCA). We found that BBTD administration effectively reduced the volume of cerebral infarction and improved neurologic functions, reduced neuronal apoptosis and neuroinflammatory. Moreover, BBTD significantly modulated the diversity and composition of the gut microbiota, including increasing the relative abundance of Lactobacillus, Prevotella and Akkermansia and decreasing relative abundances of Lachnospiraceae, Bacteroidetes (S24-7) and Ruminococcaceae. BBTD treatment also increased propionate content. Propionate mediates the the recovery of neurological functions and anti-apoptotic effects of BBTD in PCIV rat. Our findings wish to discover the potential mechanism of BBTD treatment on PCIV and promote its clinical application.
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Affiliation(s)
- Fangfang Huang
- College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Zilin Wang
- College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Zilong Zhang
- Department of Hepatobiliary-Pancreatic and Hernia Surgery, Wuhan Fourth Hospital, Wuhan 430033, China
| | - Xinbang Liu
- College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Yingda Liang
- College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Jingyi Qian
- Department of Pediatric Rehabilitation Medicine, Maternal and Child Health Hospital of HuBei Province, Wuhan, China
| | - Jia Tu
- Department of Neurology, Wuhan Hankou Hospital, Wuhan China
| | - Xuan Tang
- Department of Neurology, Wuhan Hankou Hospital, Wuhan China
| | - Chen Zhang
- Department of Emergency, Hubei Provincial Integrative Chinese and Western Medicine Hospital (Xinhua affiliated hospital, Hubei University of Chinese Medicine), Wuhan 430010, China
| | - Bangjiang Fang
- College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan 430065, China; Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai China.
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d’Annunzio A, Arboix A, García-Eroles L, Sánchez-López MJ. Vertigo in Acute Stroke Is a Predictor of Brain Location but Is Not Related to Early Outcome: The Experience of Sagrat Cor Hospital of Barcelona Stroke Registry. Biomedicines 2022; 10:2830. [PMID: 36359352 PMCID: PMC9687911 DOI: 10.3390/biomedicines10112830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Vertigo is an uncommon symptom among acute stroke victims. Knowledge about the clinical profile, the brain location, and the early outcome in stroke patients with cerebrovascular diseases and vertigo remains limited. OBJECTIVES In this study, the effects of vertigo on cerebral topography and early prognosis in cerebrovascular diseases were investigated. METHODS A comparative analysis in terms of demographics, risk factors, clinical characteristics, stroke subtypes, cerebral and vascular topography, and early outcome was performed between patients with presence or absence of vertigo on a sample of 3743 consecutive acute stroke patients available from a 24-year ongoing single-center hospital-based stroke registry. RESULTS Vertigo was present in 147 patients (3.9%). Multiple logistic regression analysis showed that variables independently associated with vertigo were: location in the cerebellum (OR 5.59, CI 95% 3.24-9.64), nausea or vomiting (OR 4.48, CI 95% 2.95-6.82), medulla (OR 2.87, CI 95% 1.31-6.30), pons (OR 2.39, CI 95% 1.26-4.51), basilar artery (OR 2.36, CI 95% 1.33-4.17), ataxia (OR 2.33, CI 95% 1.41-3.85), and headache (OR 2.31, CI 95% 1.53-3.49). CONCLUSION The study confirmed that the presence of vertigo was not related with increased in-hospital mortality or poor prognosis at hospital discharge. Vertigo is mainly related to non-lacunar vertebrobasilar stroke with topographic localization in the cerebellum and/or brainstem.
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Affiliation(s)
- Angela d’Annunzio
- Department of Neurology, Hospital Universitari Sagrat Cor, Quirónsalud, Universitat de Barcelona, 08029 Barcelona, Catalunya, Spain
| | - Adrià Arboix
- Department of Neurology, Hospital Universitari Sagrat Cor, Quirónsalud, Universitat de Barcelona, 08029 Barcelona, Catalunya, Spain
| | - Luís García-Eroles
- Department of Neurology, Hospital Universitari Sagrat Cor, Quirónsalud, Universitat de Barcelona, 08029 Barcelona, Catalunya, Spain
| | - María-José Sánchez-López
- Medical Library, Hospital Universitari Sagrat Cor, Quirónsalud, Universitat de Barcelona, 08029 Barcelona, Catalunya, Spain
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Deng Y, Zhang L, Zhang R, Duan J, Huang J, Qiu D. Clinical Features Differ Between Patients With Vertigo Attack Only and Weakness Attack Accompanying Vertigo Before Vertebrobasilar Stroke: A Retrospective Study. Front Neurol 2022; 13:928902. [PMID: 35968280 PMCID: PMC9363826 DOI: 10.3389/fneur.2022.928902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/22/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To determine the different clinical features of patients with vertigo attacks alone and of those with weakness accompanying vertigo attacks before the vertebrobasilar ischemic stroke. Methods In this 4-year retrospective study, we manually screened the medical records of 209 patients, hospitalized with vertigo attack as the main complaint who were finally diagnosed with acute vertebrobasilar ischemic stroke. Patients were divided into two groups according to their symptoms: patients who only experienced vertigo attacks prior to the vertebrobasilar stroke (VO group) and patients who had both vertigo and weakness attacks (VW group) prior to the stroke. Clinical parameters, such as infarction site and volume, relative risk factors, ABCD2 score, and medical intervention, were compared between the two groups. Results The prevalence of hypertension was higher in the Vertigo attacks only (VO) group (42.2 vs. 29.0%, p < 0.05). The total cerebral infarction volume in the VO group was larger than the Vertigo and weakness attacks (VW) group (4.44 vs. 2.12 cm3, p < 0.05). Additionally, the cerebellum was more likely to be affected in the VO group. In contrast, patients in the VW group had higher carotid stenosis (14.2 vs. 27.2%, p < 0.05) and ABCD2 score (2.1 ± 1.2 vs. 3.6 ± 1.5, p = 0.02). The percentage of patients with medullary infarctions also increased in the VW group. Vertigo attack events occurred more frequently in the VW group (median 2.4 vs. 4.3, p < 0.04). We also found that the patients in the VW group were more likely to seek medical intervention after vertigo. Conclusions Clinical parameters, such as infarction location, relative risk factors, and ABCD2 score, differed between patients with vertigo symptoms with or without weakness attacks. These findings highlight the different clinical features of patients with vertigo attack only and those with weakness attacks accompanying vertigo prior to vertebrobasilar ischemic stroke.
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Affiliation(s)
- Yalan Deng
- Department of Oncology, NHC Key Laboratory of Cancer Proteomics, Laboratory of Structural Biology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lei Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Rongsen Zhang
- Department of Ultrasonography, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jingfeng Duan
- Department of Neurology, Third Hospital of Changsha, Changsha, China
| | - Jiabing Huang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Jiabing Huang
| | - Dongxu Qiu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Dongxu Qiu
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Machine Learning Techniques for Differential Diagnosis of Vertigo and Dizziness: A Review. SENSORS 2021; 21:s21227565. [PMID: 34833641 PMCID: PMC8621477 DOI: 10.3390/s21227565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 01/23/2023]
Abstract
Vertigo is a sensation of movement that results from disorders of the inner ear balance organs and their central connections, with aetiologies that are often benign and sometimes serious. An individual who develops vertigo can be effectively treated only after a correct diagnosis of the underlying vestibular disorder is reached. Recent advances in artificial intelligence promise novel strategies for the diagnosis and treatment of patients with this common symptom. Human analysts may experience difficulties manually extracting patterns from large clinical datasets. Machine learning techniques can be used to visualize, understand, and classify clinical data to create a computerized, faster, and more accurate evaluation of vertiginous disorders. Practitioners can also use them as a teaching tool to gain knowledge and valuable insights from medical data. This paper provides a review of the literatures from 1999 to 2021 using various feature extraction and machine learning techniques to diagnose vertigo disorders. This paper aims to provide a better understanding of the work done thus far and to provide future directions for research into the use of machine learning in vertigo diagnosis.
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Lee H, Kim HA. Reversal of spontaneous nystagmus during visual fixation in dorsal medullary infarction. J Neurol 2020; 267:1547-1549. [PMID: 32052164 DOI: 10.1007/s00415-020-09754-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Hyung Lee
- Department of Neurology, Keimyung University School of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea.,Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea
| | - Hyun Ah Kim
- Department of Neurology, Keimyung University School of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea. .,Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea.
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Effect of Intermittent Hypoxia Training for Dizziness: A Randomized Controlled Trial. J Sport Rehabil 2019; 28:540-543. [PMID: 29584516 DOI: 10.1123/jsr.2017-0341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/25/2018] [Accepted: 03/06/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the effect of intermittent hypoxia training (IHT) for dizziness. DESIGN A single-blind, randomized controlled trial. All participants were recruited from a rehabilitation department in an acute university-affiliated hospital. INTERVENTION Participants with dizziness were randomly assigned to 2 groups (IHT group and control group). The Dizziness Handicap Inventory, Activities-specific Balance Confidence Scale, and Vertigo Visual Analog Scale were conducted at baseline, end of the fourth week. RESULTS Among 52 subjects, there were18 males and 34 females, ages 35 to 62 years old (mean [SD] = 46.9 [7.93]). Time length since onset ranged from 12 to 34 months (20.2 [7.15] mo). Dizziness Handicap Inventory, Activities-specific Balance Confidence Scale, Vertigo Visual Analog Scale scores, and attack frequencies of dizziness were improved after IHT intervention in the end of the fourth week. There were significant differences between the IHT group and the control group in the Dizziness Handicap Inventory, Activities-specific Balance Confidence Scale, Vertigo Visual Analog Scale scores, and attack frequencies of dizziness at the end of the fourth week (P < .05). No adverse events occurred during the study. CONCLUSION IHT could improve dizziness after intervention at the end of the fourth week. IHT could be the effective method for treating dizziness.
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Abstract
INTRODUCTION This study was aimed to determine risk factors for central vertigo (CV) in patients with isolated vertigo accompanied by hearing loss or not. PATIENTS AND METHODS Patients with CV or peripheral vertigo (PV) who were admitted to our hospital between January 2014 and July 2016 were retrospectively reviewed. All patients underwent thorough physical examination with detailed medical histories recorded, including smoking, hypertension, diabetes, cardiovascular disease, and stroke history. Logistic regression estimated odds ratio (OR) of the risk factors. RESULTS Eighty-seven patients were enrolled into the study, including 41 cases of CV and 46 cases of PV. There was significant difference in sex, age above 60, hypertension, diabetes, smoking, and stroke history between the 2 groups. The patients without any risk factors did not have CV. The risk for CV in the patients with ≥3 risk factors was greater (OR, 11.43; 95% confidence interval, 3.27-39.93; P<0.001) than the patients with 1 risk factor. The risk for CV in the patients with 2 risk factors was similar (OR, 0.833; 95% confidence interval, 0.17-4.28; P=0.825) to the patients with 1 risk factor. CONCLUSION The patients with isolated vertigo (accompanied by hearing loss or not) and 3 or more risk factors are at higher risk for CV. They should have a comprehensive neurological examination and be closely followed up.
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Kattah JC, Saber Tehrani AS, Roeber S, Gujrati M, Bach SE, Newman Toker DE, Blitz AM, Horn AKE. Transient Vestibulopathy in Wallenberg's Syndrome: Pathologic Analysis. Front Neurol 2017; 8:191. [PMID: 28567027 PMCID: PMC5434105 DOI: 10.3389/fneur.2017.00191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 04/20/2017] [Indexed: 01/14/2023] Open
Abstract
Objective To report an unusual lateral medullary stroke (LMS) associated with transient unidirectional horizontal, nystagmus, and decreased horizontal vestibulo–ocular reflex (h-VOR) gain that mimicked a peripheral vestibulopathy. MRI suggested involvement of caudal medial vestibular nucleus (MVN); however, the rapid resolution of the nystagmus and improved h-VOR gain favored transient ischemia without infarction. Decreased h-VOR gain is expected with peripheral vestibular lesions within the labyrinth or superior vestibular nerve; less frequently lateral pontine strokes involving the vestibular root entry, the vestibular fascicle, or neurons within the MVN may be responsible. The h-VOR is typically normal in LMS. Methods Clinicopathologic examination of a 61-year-old man with an acute vestibular syndrome (AVS) and left LMS who died 3 weeks after the stroke. Postmortem brainstem analysis was performed. Results The stroke involved the lateral medulla and pontomedullary junction, near the MVN, sparing the cerebellum and pons. To explain transient vestibular findings there are two possible hypotheses; the first would be that the MVN survived the ischemic process and would be histologically intact, and the second that vestibular afferents in the horizontal semicircular canal were ischemic and recovered after the ischemic process. Neuropathological examination showed a left LMS whose extent matched that seen by imaging. Non-ocular motor signs correlated well with structures affected by the infarction. Neurons and glia within nearby MVN were spared, as predicted by the rapid normalization of the ocular motor signs. Although unlikely, the possibility of transient intralabyrinthine arteriolar ischemia cannot be excluded. Additionally, truncal lateropulsion was due to combined lateral vestibulospinal tract and lateral reticular nucleus infarction. Conclusion LMS may rarely be associated with an AVS that either represents or mimics a peripheral vestibulopathy. To our knowledge, this is the first neuropathologic examination of the brainstem of an LMS associated with transient vestibular findings occurring in the context of an anterior/posterior (AICA/PICA) cerebellar arterial variant stroke.
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Affiliation(s)
- Jorge C Kattah
- Department of Neurology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Ali S Saber Tehrani
- Department of Neurology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Munich, Germany
| | - Meena Gujrati
- Department of Neurology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Sarah E Bach
- Department of Neurology, University of Illinois College of Medicine, Peoria, IL, USA
| | - David E Newman Toker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ari M Blitz
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anja K E Horn
- Institute of Anatomy and Cell Biology I, German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Munich, Germany
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