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Patel R, Lele P. Anterior Canal BPPV- A Rare Form of Vertical Canaloliathiasis: Series of 11 Cases. Indian J Otolaryngol Head Neck Surg 2024; 76:3345-3352. [PMID: 39130282 PMCID: PMC11306467 DOI: 10.1007/s12070-024-04686-9] [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: 11/11/2023] [Accepted: 04/04/2024] [Indexed: 08/13/2024] Open
Abstract
The most common cause of peripheral vertigo is Benign Paroxysmal Positional Vertigo (BPPV) primarily due to involvement of posterior semicircular canal. BPPV due to anterior canal is rare entity. This is a retrospective study, in which data of 628 patients who underwent vertigo test were analyzed. Amongst which 354 were patients of BPPV. It was found that 305 patients had posterior canal BPPV, 18 patients had lateral canal BPPV and 11 patients had anterior canal BPPV. The VNG data of 11 patients with anterior canal BPPV along with their treatment outcomes was analyzed. Of the eleven patients of anterior canal BPPV, ten patients had torsional nystagmus with or without downbeat nystagmus in Deep Head Hanging test. Only one patient had isolated downbeat nystagmus in Supine Head Hanging Test. Patients were treated with modified Yacovino's maneuver. Eight patients had immediate relief with modified Yacovino's repositioning maneuver. One patient had immediate conversion to left posterior canal BPPV and was treated for the same. Two patients presented with delayed conversion to posterior canal BPPV and were treated for the same. Anterior canal BPPV is rare but existent entity. It has a typical torsional and downbeat Nystagmus which is induced by Dix-Hallpike and Deep head hanging test. There is no reversal of nystagmus on getting up. It can be easily corrected by Yacovino's maneuver in the majority of the cases.
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Affiliation(s)
- Rushika Patel
- Lele ENT Hospital and Research Centre, Kulkarni Garden, Sharanpur Road, Nashik, 422002 Maharashtra India
- Dr Vasantrao Pawar Medical College,Hospital and Research Centre, Adgaon,Nashik, Maharashtra 422001 India
| | - Pushkar Lele
- Lele ENT Hospital and Research Centre, Kulkarni Garden, Sharanpur Road, Nashik, 422002 Maharashtra India
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Skelmose TBK, Houmøller AM, Yavarian Y, Borregaard NR, Hougaard DD. Individualized repositioning with a mechanical rotational chair facilitates successful treatment of patients with very retractable benign paroxysmal positional vertigo. Am J Otolaryngol 2024; 45:104241. [PMID: 38574512 DOI: 10.1016/j.amjoto.2024.104241] [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: 11/26/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND About 12.5 % of patients diagnosed with benign paroxysmal positional vertigo (BPPV), experience persistent BPPV where it is unknown why some BPPV cases are very refractory (vrBPPV) to treatment. OBJECTIVES The primary objective was to investigate if patients with vrBPPV could be successfully treated with a mechanical rotation chair (MRC) adjusted to the exact vertical semicircular canal (SCC) angles of the individual patient. Secondary endpoint was to determine if inner ear anomalies were predominant in these patients. METHODS This prospective clinical trial included 20 patients (main group) who underwent computed tomography (CT) with measurements of the bony island and the width between the SCC walls of the posterior leg of the lateral SCCs. The inter-SCC angles, the angles between the sagittal plane and the vertical SCCs were compared to the presumed mean standard angles of the SCCs. Of these, 14 patients (subgroup) underwent individualized treatment with the Rotundum® repositioning chair according to their measured SCC angles. RESULTS All measured SCC angles differed significantly (p < 0.05) from the presumed mean standard SCC angles, except the angle between the sagittal plane and the left posterior SCC (p-SCC). Three out of 14 patients experienced subjective and objective remission after treatment with this MRC. Six out of 14 patients experienced either subjective remission or objective remission. CONCLUSIONS Patients with vrBPPV have vertical SCC angles that differ significantly from the presumed mean standard SCC angles. Individualized treatment with this MRC successfully treated 21.4 % of the patients with vrBPPV and provided subjective relief for 42.9 %.
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Affiliation(s)
| | | | - Yousef Yavarian
- Department of Radiology, Aalborg University Hospital, Denmark
| | | | - Dan Dupont Hougaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Balance & Dizziness Centre, Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
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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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Porwal P, V R A, Pawar V, Dorasala S, Bijlani A, Nair P, Nayar R. Clinical and VNG Features in Anterior Canal BPPV-An Analysis of 13 Cases. Front Neurol 2021; 12:618269. [PMID: 33776883 PMCID: PMC7988206 DOI: 10.3389/fneur.2021.618269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/08/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To define diagnostic VNG features in anterior canal BPPV during positional testing (Dix-Hallpike, supine head hanging, and McClure Pagnini tests). Study Design: A retrospective study of patients diagnosed with anterior canal BPPV across four referral centers in New Delhi, Kochi, Bangalore, and Dubai. Subjects and Methods: Clinical records of 13 patients with AC BPPV out of 1,350 cases, during a 3-years period, were reviewed and analyzed by four specialists. Results: Four patients had positional down beating nystagmus with symptoms of vertigo during the bilateral DHP maneuver. Seven cases had positional down beating nystagmus only on one side of DHP. Typical down beating nystagmus was seen in 10 out of 13 cases during the straight head hanging maneuver. Down beating torsional nystagmus was seen in 6 out of 13 cases. Down beating with horizontal nystagmus was seen in three cases (in DHP and MCP mainly) while pure down beating nystagmus during SHH was only seen in four cases. Conclusion: We conclude that anterior canal BPPV is a rare but definite entity. It may not be apparent on positional testing the first time, so repeated testing may be needed. The most consistent diagnostic maneuver is SHH though there were patients in which findings could only be elicited using DHP testing. We recommend a testing protocol that includes DHP testing on both sides and SHH. MCP testing may also evoke DBN with or without the torsional component. Reversal of nystagmus on reversal of testing position is unusual but can occur. The Yacovino maneuver is effective in resolving AC BPPV. We also propose a hypothesis that explains why DHP testing is sensitive to AC BPPV on either side, whereas MCP lateral position on one side is only sensitive to AC BPPV on one side. We have explained a possible role for the McClure Pagnini test in side determination and therapeutic implications.
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Affiliation(s)
| | - Ananthu V R
- Vertigo and Balance Clinic, Bangalore, India
| | - Vishal Pawar
- Aster Clinic, Zen Cluster, Discovery Gardens, Dubai, United Arab Emirates
| | - Srinivas Dorasala
- Ear, Nose and Throat (ENT) Department, Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | | | - Prem Nair
- Department of Speech Pathology and Audiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Ravi Nayar
- Centre of Academics Research, HCG, Bangalore, India
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Franco-Gutiérrez V, Pérez-Guillén V, Gil-Aguilar MT, Franco-Gutiérrez R, Álvarez-Zapico MJ, García-Zamora E, Pérez-Vázquez P. Comparative analysis of the efficiency of two treatment protocols for posterior canal benign paroxysmal positional vertigo. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(20)30201-6. [PMID: 33483093 DOI: 10.1016/j.otorri.2020.11.006] [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: 09/24/2020] [Revised: 11/06/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Benign paroxysmal positional vertigo (BPPV) is the most common vertigo of labyrinthine origin, its social and healthcare impact is remarkable. It has recently been shown that single session treatment is as safe and effective as weekly treatment, which could have impact on direct and indirect costs related to the disease. The objective of this study is to determine whether single session treatment of unilateral posterior canal BPPV canalolithiasis is more efficient than conventional treatment. MATERIALS AND METHODS A prospective randomized controlled trial was performed in 53 consecutive patients diagnosed with unilateral posterior canal BPPV canalolithiasis previously untreated: 26 patients were assigned to single session treatment and 27 patients to weekly treatment. Average and total cost of care, consultation time and the impact in terms of temporary disability and loss of productivity for the company due to patients' medical visits were compared. RESULTS Average and total cost of care and loss of productivity for the company due to patients' medical visits were significantly lower in the single session group. Consultation time was also better in this group when travelling time was considered. CONCLUSIONS The single session protocol is fast, effective and reduces direct and indirect cost of care related to disease justifying high resolution consultations.
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Affiliation(s)
- Virginia Franco-Gutiérrez
- Servicio de Otorrinolaringología, Hospital Carmen y Severo Ochoa, Cangas del Narcea, Asturias, España.
| | - Vanessa Pérez-Guillén
- Servicio de Otorrinolaringología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Raúl Franco-Gutiérrez
- Servicio de Cardiología, Hospital Universitario Lucus Augusti, Lugo, Galicia, España
| | | | - Enrique García-Zamora
- Servicio de Otorrinolaringología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Paz Pérez-Vázquez
- Servicio de Otorrinolaringología, Hospital de Cabueñes, Gijón, Asturias, España
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Yao Q, Wang H, Song Q, Shi H, Yu D. Use of the Bárány Society criteria to diagnose benign paroxysmal positional vertigo. J Vestib Res 2019; 28:379-384. [PMID: 30814370 DOI: 10.3233/ves-190648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder affecting about 20% of dizzy patients. Early diagnosis and treatment can improve the quality of life for patients. OBJECTIVE We reviewed the classifications of different subtypes of benign paroxysmal positional vertigo and the problems we encountered using the diagnostic criteria of the Bárány Society. METHODS Both the Dix-Hallpike maneuver and supine roll test were performed on 568 patients, and diagnoses were made based on patient history and the type of provoked nystagmus (if any). Next, the numbers of patients with each subtype and other parameters, including age and sex, were analyzed. RESULTS Posterior semicircular canal BPPV (pc-BPPV) accounted for the largest proportion, followed by horizontal semicircular canal BPPV (hc-BPPV). Both anterior canal BPPV and multiple canal lithiasis BPPV were rare, and no patient was diagnosed with cupulolithiasis of the posterior canal. CONCLUSIONS pc-BPPV, hc-BPPV, and cupulolithiasis of the horizontal canal (hc-BPPV-cu) were the three major subtypes that could be definitively diagnosed, whereas the diagnoses of possible benign paroxysmal positional vertigo (pBPPV) and probable benign paroxysmal positional vertigo [spontaneously resolved] (pBPPVsr) require further investigation, with special attention being paid to appropriate differentiation and repositioning maneuvers.
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Affiliation(s)
- Qingxiu Yao
- From the Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hui Wang
- From the Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qiang Song
- From the Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haibo Shi
- From the Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Dongzhen Yu
- From the Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Tang X, Huang Q, Chen L, Liu P, Feng T, Ou Y, Zheng Y. Clinical Findings in Patients With Persistent Positional Nystagmus: The Designation of "Heavy and Light Cupula". Front Neurol 2019; 10:326. [PMID: 31024424 PMCID: PMC6465512 DOI: 10.3389/fneur.2019.00326] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/15/2019] [Indexed: 11/20/2022] Open
Abstract
Objective: Direction-changing positional nystagmus (DCPN) had been observed as persistent horizontal apogeotropic and was considered as “cupulolithiasis or heavy cupula. ” Recently, the concept of “light cupula” exhibiting persistent geotropic DCPN has been introduced. However, the light cupula is not systematically described, while the identification and diagnosis of “light cupula” should be improved. Here we investigated the underlying characteristics and therapeutic options designed to the “light” and “heavy” cupula, respectively; and summarized the clinical characteristics and therapeutic effect in the two groups. Methods: A total of 359 cases with vertigo and bilateral DCPN were found in the supine roll test. Only 25 patients with persistent DCPN were enrolled and followed up. According to the direction of nystagmus, we further divided the patients into “heavy cupula” (apogeotropic) and “light cupula” (geotropic) groups. We compared the incidence, characteristics of nystagmus and the efficacy of repositioning maneuver in the two groups. Results: Nine patients with persistent horizontal geotropic DCPN were confirmed as “light cupula,” other 16 patients with persistent horizontal ageotropic DCPN were confirmed as heavy cupula. All 25 patients had null plane; the mean value and standard deviation of the null plane in light cupula and heavy cupula was 25.67 ± 9.31° and 27.06 ± 6.29°, respectively. The mean value and standard deviation of the termination plane in light cupula was 28.78 ± 10.00°, and 30.25 ± 6.53° in heavy cupula. There was no statistical significance between the two groups. We found that the direction of evoked nystagmus in the supine position was toward the intact side in light cupula, while in heavy cupula, it was toward the lesion side. The null plane appeared on the lesion side. For light cupula patients, the effect was not obvious at Day-7 after the treatment, however, treatment for most heavy cupula patients were effective. All patients recovered after 30 days of treatment. Conclusion: The null plane is crucial in determining the lesion side for light or heavy cupula. Although the short-term therapeutic effect of the light cupula is not as promising as the effect seen in heavy cupula, the long-term prognosis in both groups is comparable; with all patients recovered after 30 days of treatment. Study design: This is a retrospective cohort study.
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Affiliation(s)
- Xiaowu Tang
- Department of Otolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Hearing and Speech-language Science, Sun Yat-Sen University, Guangzhou, China.,Xinhua College Sun Yat-Sen University, Guangzhou, China
| | - Qiuhong Huang
- Department of Otolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Hearing and Speech-language Science, Sun Yat-Sen University, Guangzhou, China.,Xinhua College Sun Yat-Sen University, Guangzhou, China
| | - Ling Chen
- Department of Otolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Hearing and Speech-language Science, Sun Yat-Sen University, Guangzhou, China.,Xinhua College Sun Yat-Sen University, Guangzhou, China
| | - Peng Liu
- Department of Otolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Hearing and Speech-language Science, Sun Yat-Sen University, Guangzhou, China.,Xinhua College Sun Yat-Sen University, Guangzhou, China
| | - Tianci Feng
- Department of Otolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Hearing and Speech-language Science, Sun Yat-Sen University, Guangzhou, China.,Xinhua College Sun Yat-Sen University, Guangzhou, China
| | - Yongkang Ou
- Department of Otolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Hearing and Speech-language Science, Sun Yat-Sen University, Guangzhou, China.,Xinhua College Sun Yat-Sen University, Guangzhou, China
| | - Yiqing Zheng
- Department of Otolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Hearing and Speech-language Science, Sun Yat-Sen University, Guangzhou, China.,Xinhua College Sun Yat-Sen University, Guangzhou, China
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Yang X, Yang B, Wu M, Wang F, Huang X, Li K, Mao Z, Xu Z, Ren H. Association Between Serum Uric Acid Levels and Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis of Observational Studies. Front Neurol 2019; 10:91. [PMID: 30828314 PMCID: PMC6385523 DOI: 10.3389/fneur.2019.00091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/23/2019] [Indexed: 12/20/2022] Open
Abstract
Objective: The objective of the present study was to meta-analyze relevant literature to gain a comprehensive understanding of the potential relationship between serum uric acid levels and risk of benign paroxysmal positional vertigo (BPPV). Methods: The databases of PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure, Wanfang, and SinoMed were systematically searched for observational case-control studies of the association between BPPV and serum uric acid levels published up to October 2018. Data from eligible studies were meta-analyzed using Stata 12.0. Results: A total of 12 studies were included in the analysis. There was a strong tendency for serum uric acid levels to be associated with risk of BPPV among studies conducted in China (OR 0.69, 95%CI 0.01–1.40, p = 0.053), but not among studies outside China (OR 1.07, 95%CI 1.08–3.22, p = 0.33). Across all studies, serum uric acid level was significantly higher among individuals with BPPV than among controls (OR 0.78, 95%CI 0.15–1.41, p = 0.015), yet it did not independently predict risk of the disorder (OR 1.003, 95%CI 0.995–1.012, p = 0.471). Conclusion: The available evidence suggests that BPPV is associated with elevated levels of serum uric acid, but these levels may not be an independent risk factor of BPPV.
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Affiliation(s)
- Xinglong Yang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Baiyuan Yang
- Department of Neurology, Seventh People's Hospital of Chengdu, Chengdu, China
| | - Mengjun Wu
- Department of Anesthesiology, Chengdu Women and Children's Central Hospital, Chengdu, China
| | - Fang Wang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaodong Huang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kelu Li
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhiwei Mao
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhong Xu
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hui Ren
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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