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Varghese SS, Varghese A, Kumar N. Adoption of the international classification of vestibular disorders criteria in cases of Benign positional paroxysmal vertigo: a single-center experience. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08794-8. [PMID: 38977478 DOI: 10.1007/s00405-024-08794-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Benign positional paroxysmal vertigo (BPPV) stands as the commonest cause for vertigo. It accounts for 20% of all cases of vertigo, even with its high prevalence rate it often goes underdiagnosed and undertreated. Development of the consensus document by the Bárány society's International Classification of Vestibular Disorders (ICVD)significantly facilitates the diagnosis of BPPV and its variants. This study assesses the utilisation of ICVD criteria for managing BPPV. METHODOLOGY This is a cross-sectional descriptive study conducted at a tertiary care hospital in Northern India spanning from November 1, 2022, to November 30, 2023. A total of 110 participants diagnosed with BPPV were enrolled consecutively. All participants underwent Dix-Hallpike and supine log roll positional maneuvers. Diagnosis was made based on the history and type of nystagmus seen, and classified as per the ICVD criteria. RESULTS Posterior semicircular canalolithiasis (pc-BPPV) accounted for 25.45% of cases and horizontal canal canalolithiasis (hc-BPPV) accounted for 20.91% of cases. Probable BPPV, spontaneously resolved (pBPPVsr) was diagnosed in 16.36% of participants and possible BPPV(pBPPV) was diagnosed in 18.18% of participants. Multiple canal BPPV (mc-BPPV) accounted for 17.27% of cases. One participant was diagnosed with horizontal canal cupulolithiasis and anterior canal canalolithiasis respectively. No participant was diagnosed with posterior canal cupulolithiasis. CONCLUSION The most common type of BPPV was pc-BPPV followed by hc-BPPV. The affected canal in possible BPPV, can be identified, and appropriate repositioning maneuvers are effective in treating them as well as aids in confirming the diagnosis. The diagnostic clarity provided by ICVD, aids in effective management of BPPV. More studies with larger sample size are required to further validate its clinical utility.
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Affiliation(s)
- Sunil Sam Varghese
- Department of E.N.T, Chrisitan medical college, Brown Road, Ludhiana, 141008, Punjab, India.
| | - Ashish Varghese
- Department of E.N.T, Bangalore Baptist Hospital, Bellary Road, Hebbal, Bengaluru, Karnataka, India
| | - Navneet Kumar
- Department of E.N.T, Chrisitan medical college, Brown Road, Ludhiana, 141008, Punjab, India
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Cao W, Geng Y, Chang J, Li F. Risk factors for benign paroxysmal positional vertigo and construction of a nomogram predictive model. Am J Transl Res 2024; 16:2435-2444. [PMID: 39006265 PMCID: PMC11236668 DOI: 10.62347/dhaj4799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/24/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND To analyze the risk factors for benign paroxysmal positional vertigo (BPPV) and to construct a predictive nomogram model. METHODS In this retrospective study, 312 participants were enrolled, including 164 BPPV patients and 148 healthy subjects without BPPV. Risk predictors for BPPV were identified using univariate and multivariate analyses, and a clinical nomogram was constructed. The predictive accuracy was assessed by unadjusted concordance index (C-index) and calibration plot. RESULTS Univariate and multivariate regression analysis identified stroke (95% CI, 0.575-5.954; P=0.022), hyperlipidemia (95% CI, 0.471-4.647; P=0.003), chronic suppurative otitis media (95% CI, 1.222-45.528; P=0.005), cervical spondylosis (95% CI, 1.232-3.017; P=0.005), and osteoporosis (95% CI, 1.130-3.071; P=0.001) were the independent risk factors for BPPV. These risk factors were used to construct a clinical predictive nomogram. The regression equation was: logit (P) = -6.820 + 0.450 * stroke + hyperlipidemia * 0.312 + chronic suppurative otitis media * 0.499 + cervical spondylosis * 0.916 + osteoporosis * 0.628. The calibration curves demonstrated excellent accuracy of the predictive nomogram. Decision curve analysis showed that the predictive model is clinically applicable when the threshold probability was between 20% and 60%. CONCLUSIONS Stroke, hyperlipidemia, chronic suppurative otitis media, cervical spondylosis and osteoporosis are independent risk predictors for BPPV. The developed nomogram is useful in predicting the risk of BPPV.
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Affiliation(s)
- Wenping Cao
- Department of Otolaryngology, Zibo Central Hospital Zibo 255000, Shandong, China
| | - Yang Geng
- Department of Otolaryngology, Zibo Central Hospital Zibo 255000, Shandong, China
| | - Jun Chang
- Operating Room, Zibo Central Hospital Zibo 255000, Shandong, China
| | - Feifei Li
- Department of Otolaryngology, Zibo Central Hospital Zibo 255000, Shandong, China
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Chen Z, Liu Y, Lin C, Liu D, Xiao L, Liu H, Wei X, Rong L. Altered parietal operculum cortex 2 functional connectivity in benign paroxysmal positional vertigo patients with residual dizziness: A resting-state fMRI study. CNS Neurosci Ther 2024; 30:e14570. [PMID: 38421104 PMCID: PMC10850607 DOI: 10.1111/cns.14570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 03/02/2024] Open
Abstract
AIMS To investigate changes in functional connectivity (FC) focusing on parietal operculum cortex 2 (OP2) in benign paroxysmal positional vertigo (BPPV) patients with residual dizziness (RD) after successful canalith repositioning procedure (CRP). METHODS High-resolution three-dimensional T1 and resting-state functional magnetic resonance imaging (fMRI) were performed on 55 healthy controls (HCs), 55 BPPV patients with RD, and 55 patients without RD after successful CRP. Seed-based (bilateral OP2) FC was calculated to investigate the changes in FC among the three groups. Additionally, we further explored the associations between abnormal FC and clinical symptoms. RESULTS One-way analysis of covariance showed significant FC differences among the three groups. Post-hoc analysis showed that patients with RD exhibited decreased FC between left OP2 and regions of left angular gyrus (AG), thalamus, precuneus, middle frontal gyrus (MFG), and right cerebellum posterior lobe (CPL) in comparison with HCs. In addition, compared with patients without RD, patients with RD showed decreased FC between left OP2 and regions of left MFG, AG, middle temporal gyrus, and right CPL. Moreover, in patients with RD, the FC between left thalamus and OP2 was negatively correlated with duration of RD, and the FC between left AG and OP2 was negatively correlated with duration of BPPV. CONCLUSION BPPV patients with RD showed reduced FC between brain regions involved in vestibular processing and spatial cognition; These results suggested that BPPV patients with RD might have diminished central processing of vestibular information and impaired spatial cognition.
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Affiliation(s)
- Zhengwei Chen
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Yueji Liu
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Cunxin Lin
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Dan Liu
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Lijie Xiao
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Haiyan Liu
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Xiu‐e Wei
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Liangqun Rong
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
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Alfarghal M, Singh NK, Algarni MA, Jagadish N, Raveendran RK. Treatment efficacy of repositioning maneuvers in multiple canal benign paroxysmal positional vertigo: a systematic review and meta-analysis. Front Neurol 2023; 14:1288150. [PMID: 38020643 PMCID: PMC10658715 DOI: 10.3389/fneur.2023.1288150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Benign paroxysmal positional vertigo (BPPV) involving the posterior canal is more common than other canals; however, simultaneous involvement of multiple canals can be seen up to 20% of all BPPV cases. The diagnosis and management of multiple canal BPPV can be quite challenging due to the complexity of findings. Therefore, this systematic review and meta-analysis aimed at unveiling the most effective repositioning strategy for the treatment of multiple canal BPPV. Methods A literature search through PubMed, Scopus, and Web of Science databases was conducted using search terms such as BPPV, multiple canals, bilateral BPPV, repositioning maneuvers etc. After duplicate removal, the retained articles underwent various stages of elimination by two independent reviewers, and a third reviewer resolved the discrepancy between them. Results A total of 22 articles were included in the systematic review. These publications documented 5,196 patients diagnosed with BPPV, of which 513 had multiple canal BPPV. Of 295 individuals with multiple canal BPPV, 58.9% were effectively treated in 1 session, whereas 18.3 and 4.4% achieved a symptom-free state after two and three sessions, respectively. Failure of treatment using repositioning maneuvers was found in 18.4%. Possible implications This study offers insight into the real world of BPPV management in single and multiple canal BPPV. It is evident that repositioning maneuvers provide rapid and long-lasting relief of BPPV in most single canal BPPV patients; however, multiple canal BPPV often requires repeated treatment, and the risk of recurrence is higher in this variety than the single canal BPPV.
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Affiliation(s)
- Mohamad Alfarghal
- Otolaryngology-Head and Neck Section, Surgery Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | | | - Mohammed Abdullah Algarni
- Otolaryngology-Head and Neck Section, Surgery Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Nirmala Jagadish
- All India Institute of Speech and Hearing (AIISH), Mysore, India
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Kalmanson O, Foster CA. Cupulolithiasis: A Critical Reappraisal. OTO Open 2023; 7:e38. [PMID: 36998555 PMCID: PMC10046726 DOI: 10.1002/oto2.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/04/2023] [Accepted: 01/21/2023] [Indexed: 03/06/2023] Open
Abstract
Objective To review the history and pathophysiologic theories for cupulolithiasis and canalith jam in benign paroxysmal positional vertigo. Data Sources PubMed, Google Scholar. Review Methods Three PubMed and Google Scholar searches were performed, keywords: "cupulolithiasis," "apogeotropic [and] benign," and "canalith jam," resulting in 187 unique full-text articles in English or with English translation. Figures-Labyrinthine photographs were obtained of fresh utricles, ampullae, and cupulae of a 37-day-old mouse. Conclusions Freely moving otoconial masses explain most cases (>98%) of benign paroxysmal positional vertigo. Evidence that otoconia adhere strongly or persistently to the cupula is lacking. Apogeotropic nystagmus in the horizontal canal form is often attributed to cupulolithiasis; however, periampullary canalithiasis explains self-limited nystagmus, and reversible canalith jam explains prolonged apogeotropic nystagmus. Treatment-resistant cases can be explained by entrapment of particles in the canals or ampullae, but persistent adherence to the cupula remains theoretical. Implications for Practice Apogeotropic nystagmus is usually due to freely moving particles and should not be used in studies of horizontal canal benign paroxysmal positional vertigo as the sole method to define entrapment or cupulolithiasis. Caloric testing and imaging may help differentiate jam from cupulolithiasis. Treatment for apogeotropic benign paroxysmal positional vertigo should include maneuvers that rotate the head through 270° to fully clear the canal of mobile particles, using mastoid vibration or head shaking if entrapment is suspected. Canal plugging can be used for treatment failures.
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Affiliation(s)
- Olivia Kalmanson
- Department of Otolaryngology University of Colorado Anschutz SOM Boulder Colorado USA
| | - Carol A. Foster
- Department of Otolaryngology University of Colorado Anschutz SOM Boulder Colorado USA
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Wang W, Yan S, Zhang S, Han R, Li D, Liu Y, Zhang T, Liu S, Wu Y, Li Y, Yang X, Gu P. Clinical Application of Different Vertical Position Tests for Posterior Canal-Benign Paroxysmal Positional Vertigo-Cupulolithiasis. Front Neurol 2022; 13:930542. [PMID: 35903115 PMCID: PMC9315446 DOI: 10.3389/fneur.2022.930542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPosterior canal-benign paroxysmal positional vertigo-cupulolithiasis (PC-BPPV-cu) is a new and controversial type of benign paroxysmal positional vertigo (BPPV). At present, there are few relevant clinical studies as to whether the Half Dix-Hallpike test (Half D-HT) induces more obvious nystagmus than the Dix Hallpike test (D-HT) and straight head hanging test (SHH) in patients with PC-BPPV-cu.ObjectivesTo investigate the clinical characteristics of PC-BPPV-cu, and analyze the diagnostic significance of the Dix-Hallpike test (D-HT), Half D-HT, and straight head hanging (SHH) test in these patients.MethodsA total of 46 patients with PC-BPPV-cu were enrolled, and divided into two groups (N = 23): a group A (induction order: D-HT, Half D-HT, SHH) and a group B (induction order: Half D-HT, D-HT, SHH).ResultsAmong 46 patients with PC-BPPV-cu, the bilateral and unilateral abnormality rates of the disease side were 5 cases and 41 cases, respectively. There were significant differences in the proportion of torsional-upbeating nystagmus and upbeating nystagmus among the three headhanging positions in 46 patients with PC-BPPV-cu (P < 0.001). The slow phase velocity (SPV) of induced nystagmus at half D-HT supine position was slower than D-HT supine position (P < 0.05) and SHH supine position (P < 0.05). The nystagmus latency of D-HT supine position was significantly shorter than half D-HT (P < 0.05) and SHH (P < 0.05). PC-BPPV-cu patients were accompanied by 53.5% semicircular canal paresis, 69.6% audiological abnormalities, 76% cervical vestibular evoked myogenic potential (cVEMP), and 75% video head impulse test (vHIT) abnormalities, the concordance rates of the four detection methods were similar (χ2 = 0.243, P = 0.970).ConclusionsThe Half D-HT is simple and feasible, but might have a risk of false-negative diagnoses of the torsional-upbeating nystagmus and upbeating nystagmus. The D-HT is still a classic induction method for PC-BPPV-cu. The two complement each other and may aid in the diagnosis of PC-BPPV-cu patients. Future clinical applications of Half D-HT require extensive research to determine its diagnostic efficacy.
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Affiliation(s)
- Wenting Wang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shuangmei Yan
- Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Sai Zhang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rui Han
- Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dong Li
- Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yihan Liu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ting Zhang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shaona Liu
- Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuexia Wu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya Li
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
- *Correspondence: Xu Yang
| | - Ping Gu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
- Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, China
- Ping Gu
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Özel HE, Karakuzu AT, Temir H, Alpay M, Özdoğan F, Genç S. Effect of ocular fixation on positional nystagmus in BPPV patients. Int J Audiol 2022:1-6. [PMID: 35438599 DOI: 10.1080/14992027.2022.2062579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The quantitative suppression rate of positional nystagmus (PN) by ocular fixation (OF) is unknown. This study aims to analyse the effect of OF on the slow phase velocity (SPV) of PN during diagnostic positional manoeuvres (DPMs) with videonystagmography in patients with benign paroxysmal positional vertigo (BPPV). DESIGN DPMs were performed on 58 patients with BPPV, 33 (56.9%) of whom were women. OF was initiated when PN was most evident, and recording was continued. The mean SPV of three consecutive nystagmus before (F0) and after (F1) OF initiation was calculated. The rate of suppression of PN by OF was found in percent with the formula (F0 - F1) x 100/F0. STUDY SAMPLE 58 patients were included in this study. RESULTS The mean age was 56.1 ± 11.2 (range 27-76). F0 and F1 values were calculated as 5.742 ± 5.589 and 1.948 ± 3.424 degrees/second, respectively (p < 0.001). The rate of suppression of PN by OF was found to be 66.1%. CONCLUSIONS OF significantly suppresses PN during DPMs in BPPV patients. Elimination of OF during DPMs is important for accurate diagnosis.
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Affiliation(s)
- Halil Erdem Özel
- Department of Otolaryngology, University of Health Sciences Derince Research and Training Hospital, Kocaeli, Turkey
| | - Ahmet Taha Karakuzu
- Department of Otolaryngology, University of Health Sciences Derince Research and Training Hospital, Kocaeli, Turkey
| | - Hümeyra Temir
- Department of Audiology, University of Health Sciences Derince Research and Training Hospital, Kocaeli, Turkey
| | - Muhammed Alpay
- Department of Audiology, University of Health Sciences Derince Research and Training Hospital, Kocaeli, Turkey
| | - Fatih Özdoğan
- Department of Otolaryngology, University of Health Sciences Derince Research and Training Hospital, Kocaeli, Turkey
| | - Selahattin Genç
- Department of Otolaryngology, University of Health Sciences Derince Research and Training Hospital, Kocaeli, Turkey
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Zhu Y, He X, Hu M, Mao C, Liu Z, Yang X, Yang J, Chang L. Objective findings in patients with multi-canal benign paroxysmal positional vertigo. EAR, NOSE & THROAT JOURNAL 2021:1455613211066679. [PMID: 34932919 DOI: 10.1177/01455613211066679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The study aimed to investigate the clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo (MC-BPPV). METHODS We performed a retrospective analysis of 927 patients with BPPV who were admitted to our hospital between January 1, 2016 and December 31, 2019. The clinical data of all patients were collected. The Dix-Hallpike, straight head-hanging, and supine Roll tests were performed in all patients. The nystagmus was recorded using videonystagmography. The clinical characteristics of patients with MC-BPPV and single canal BPPV (SC-BPPV) was analyzed and compared. RESULTS Among 927 patients included, 49 (5.29%) patients had MC-BPPV, 878 (94.71%) patients had SC-BPPV. There were significant differences in the male to female ratio (1:3.90 vs 1:1.81, P < .05), mean age (62.47±12.51 vs 59.04±13.72, P < .05), as well as the ratio of cupulolithiasis to canalithiasis (1:1.45 vs 1:4.78, P < .01) between patients with MC-BPPV and SC-BPPV. The frequency of involvement of PC, HC, and AC were involved for 66 (67.35%), 23 (23.47%), and 9 (9.18%) times, respectively, in patients with MC-BPPV, which were involved in 581 (66.17%), 281 (32.0%), and 16 (1.82%) patients, respectively, in patients with SC-BPPV. No significant difference was found in the frequency of involvement of PC and HC between patients with MC-BPPV and SC-BPPV, while there was significant difference in the frequency of AC involvement between 2 groups (P < .01). Ipsilateral PC-HC-BPPV (n = 18) and bilateral PC-BPPV (n=19) were the most common among patients with MC-BPPV. Twenty-six (53.06%) patients had ipsilateral MC-BPPV, 23 (46.94%) had bilateral MC-BPPV. Of the 26 patients with ipsilateral MC-BPPV, 7 patients combined with unilateral peripheral vestibular disorder. CONCLUSION Patients with MC-BPPV had a significantly older mean age at disease onset and a higher proportion of females compared with patients with SC-BPPV. Cupulolithiasis was more common in MC-BPPV. AC involvement was also much more common in MC-BPPV than in SC-BPPV.
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Affiliation(s)
- Yanhan Zhu
- Department of Neurology, Xiangyang Central hospital, 74731Affiliated hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Xiaoming He
- Department of Neurology, Xiangyang Central hospital, 74731Affiliated hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Mei Hu
- Department of Neurology, Xiangyang Central hospital, 74731Affiliated hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Chun Mao
- Department of Neurology, Xiangyang Central hospital, 74731Affiliated hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Zheng Liu
- Department of Neurology, Xiangyang Central hospital, 74731Affiliated hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, P.R. China
| | - Jing Yang
- Department of Neurology, Xiangyang Central hospital, 74731Affiliated hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Liying Chang
- Department of Neurology, Xiangyang Central hospital, 74731Affiliated hospital of Hubei University of Arts and Science, Xiangyang, China
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