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Luo L, Zhu L, Chen L, Zhou Y, Yang R. Case report: acute vestibular syndrome following a small infarct on the right dorsolateral putamen. Neurol Sci 2024; 45:4611-4613. [PMID: 38691275 DOI: 10.1007/s10072-024-07552-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/23/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Long Luo
- Department of Neurology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China
| | - Ling Zhu
- Department of Neurology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China
| | - Lei Chen
- Department of Neurology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China
| | - Yiqiong Zhou
- Department of Neurology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China
| | - Ronghe Yang
- Department of Neurology, Shaoyang Central Hospital, Shaoyang, 422000, Hunan, China.
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2
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Chang YS, Tsai MJ, Hsieh CY, Sung SF. Characteristics and risk of stroke in emergency department patients with acute dizziness. Heliyon 2024; 10:e30953. [PMID: 38770312 PMCID: PMC11103531 DOI: 10.1016/j.heliyon.2024.e30953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024] Open
Abstract
Background Acute dizziness is a common symptom in the emergency department (ED), with strokes accounting for 3 %-5 % of cases. We investigated the risk of stroke in ED patients with acute dizziness and compared stroke characteristics diagnosed during and after the ED visit. Methods We identified adult patients with acute dizziness, vertigo, or imbalance using a hospital research-based database. Patients with abdominal or flank pain were used as the comparison group. Patients with dizziness were 1:1 matched to comparison patients. Each patient was traced for up to one year until being hospitalized for a stroke. Results Out of the 24,266 eligible patients, 589 (2.4 %) were hospitalized for stroke during the ED visit. For the remaining 23,677 patients, the risk of stroke at 7, 30, 90, and 365 days after ED discharge was 0.40 %, 0.52 %, 0.71 %, and 1.25 % respectively. Patients with dizziness had a higher risk of stroke compared to the comparison group at 7, 30, 90, and 365 days. The risk ratios decreased from 5.69 (95 % confidence interval [CI], 3.34-9.68) to 2.03 (95 % CI, 1.65-2.49). Compared to patients hospitalized for stroke during the ED visit, those hospitalized for stroke after the ED visit had greater stroke severity despite a lower initial triage acuity. Patients with early stroke (≤7 days) after ED discharge were less likely to have hypertension, diabetes, hyperlipidemia, and atrial fibrillation. They mostly experienced posterior circulation stroke. Patients with late stroke (>7 days) were older and less likely to have hypertension and hyperlipidemia but more likely to have a history of prior stroke and ischemic heart disease. Their strokes were mainly located in the anterior circulation territory. Conclusions The risk of stroke after ED discharge was higher in patients with dizziness than in the comparison group, with gradually decreasing risk ratios in the following year. Patients hospitalized for stroke during and after the ED visit had different profiles of vascular risk factors and clinical characteristics.
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Affiliation(s)
- Yu-Sung Chang
- Department of Otolaryngology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Ming-Jen Tsai
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- Department of Beauty & Health Care, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
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3
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Tanaka M, Vécsei L. A Decade of Dedication: Pioneering Perspectives on Neurological Diseases and Mental Illnesses. Biomedicines 2024; 12:1083. [PMID: 38791045 PMCID: PMC11117868 DOI: 10.3390/biomedicines12051083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Welcome to Biomedicines' 10th Anniversary Special Issue, a journey through the human mind's labyrinth and complex neurological pathways [...].
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Affiliation(s)
- Masaru Tanaka
- HUN-REN-SZTE Neuroscience Research Group, Hungarian Research Network, University of Szeged, Danube Neuroscience Research Laboratory, Tisza Lajos krt. 113, H-6725 Szeged, Hungary;
| | - László Vécsei
- HUN-REN-SZTE Neuroscience Research Group, Hungarian Research Network, University of Szeged, Danube Neuroscience Research Laboratory, Tisza Lajos krt. 113, H-6725 Szeged, Hungary;
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
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4
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Gu P, Ding Y, Ruchi M, Feng J, Fan H, Fayyaz A, Geng X. Post-stroke dizziness, depression and anxiety. Neurol Res 2024; 46:466-478. [PMID: 38488118 DOI: 10.1080/01616412.2024.2328490] [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: 03/25/2023] [Accepted: 03/03/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE Vestibular and psychiatric disorders are very closely related. Previous research shows that the discomfort and dysfunction caused by dizziness in patients can affect psychological processes, leading to anxiety and depression, and the irritation of anxiety and depression can aggravate the discomfort of dizziness. But the causal relationship between dizziness in the recovery period of stroke and Post-stroke depression (PSD) / Post-stroke anxiety (PSA) is not clear. Identifying the causal relationship between them can enable us to conduct more targeted treatments. METHODS We review the epidemiology and relationship of dizziness, anxiety, and depression, along with the related neuroanatomical basis. We also review the pathophysiology of dizziness after stroke, vestibular function of patients experiencing dizziness, and the causes and mechanisms of PSD and PSA. We attempt to explore the possible relationship between post-stroke dizziness and PSD and PSA. CONCLUSION The treatment approach for post-stroke dizziness depends on its underlying cause. If the dizziness is a result of PSD and PSA, addressing these psychological factors may alleviate the dizziness. This can be achieved through targeted treatments for PSD and PSA, such as psychotherapy, antidepressants, or anxiolytics, which could indirectly improve dizziness symptoms. Conversely, if PSA and PSD are secondary to vestibular dysfunction caused by stroke, a thorough vestibular function assessment is crucial. Identifying the extent of vestibular impairment allows for tailored interventions. These could include vestibular rehabilitation therapy and medication aimed at vestibular restoration. By improving vestibular function, secondary symptoms like anxiety and depression may also be mitigated.
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Affiliation(s)
- Pan Gu
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mangal Ruchi
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jing Feng
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Huimin Fan
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Aminan Fayyaz
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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5
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Park JY, Choi JH, Kwon JH, Weon YC, Lee SM, Kim HJ, Choi SY, Oh EH, Kim HA, Lee H, Kim JS, Choi KD. Incidence, characteristics, and neuroanatomical substrates of vestibular symptoms in supratentorial stroke. J Neurol 2023; 270:2174-2183. [PMID: 36633670 DOI: 10.1007/s00415-023-11566-9] [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: 10/25/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
The incidence and characteristics of acute vestibular symptoms, responsible structures, and lateralization of the causative lesions in supratentorial stroke remain unknown. This study aimed to determine the incidence, clinical features, and anatomical correlation of acute vestibular symptoms in supratentorial stroke. We performed a prospective, multicenter, observational study that had recruited patients with supratentorial stroke from the neurology clinics of referral-based four university hospitals in Korea. All patients received a constructed neuro-otological evaluations, and neuroimaging. We analyzed the incidence of acute vestibular symptoms, abnormal ocular motor and vestibular function tests, and stroke lesions. Of 1301 patients with supratentorial stroke, 48 (3.7%) presented with acute vestibular symptoms, and 13 of them (1%) had the vestibular symptoms in isolation. In patients with acute vestibular symptoms, abnormal findings included spontaneous nystagmus (5%), impaired horizontal smooth pursuit (41%), and abnormal tilt of the subjective visual vertical (SVV) (20%). Video head impulse and caloric tests were normal in all the patients. There was no clear correlation between acute vestibular symptoms and involvement of specific vestibular cortex. In patients with unilateral stroke, there was also no lateralization of the causative lesions of acute vestibular symptoms (left vs. right; 52 vs. 48%), even in patients with vertigo (left vs. right; 58 vs. 42%). This study demonstrates that the incidence of acute vestibular symptoms in supratentorial stroke is 3.7%, with being isolated in 1%. The widespread lesions responsible for acute vestibular symptoms implicate diffuse multisensory cortical-subcortical networks in the cerebral hemispheres without a lateralization.
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Affiliation(s)
- Ji-Yun Park
- Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Jae-Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Young Cheol Weon
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Suk-Min Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, College of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea
| | - Hyo Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seo Young Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, College of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea
| | - Eun Hye Oh
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Ah Kim
- Department of Neurology, Keimyung University School of Medicine, 1095, Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea.
| | - Hyung Lee
- Department of Neurology, Keimyung University School of Medicine, 1095, Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, College of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea.
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6
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Carmona S, Martínez C, Zalazar G, Koohi N, Kaski D. Acute truncal ataxia without nystagmus in patients with acute vertigo. Eur J Neurol 2023; 30:1785-1790. [PMID: 36752029 DOI: 10.1111/ene.15729] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Differentiating between peripheral and central aetiologies can be challenging in patients with acute vertigo, given substantial symptom overlap. A detailed clinical history and focused physical eye movement examination such as the HINTS eye examination appear to be the most reliable approach to identify acute cerebellar/brainstem stroke, outperforming even acute brain imaging. We have observed, however, that isolated vertigo of central cause may be accompanied by acute truncal ataxia, in the absence of nystagmus. METHODS We explored the frequency of ataxia without concurrent nystagmus in a cross section of patients with acute vertigo who presented to the emergency department at two centres in Argentina (Group A) and the UK (Group B). Patients underwent detailed clinical neuro-otological assessments (Groups A and B), which included instrumented head impulse testing and oculography (Group B). RESULTS A total of 71 patients in Group A and 24 patients in Group B were included in this study. We found acute truncal ataxia-without nystagmus-in 15% (n = 14) of our overall cohort. Lesions involved stroke syndromes affecting the posterior inferior cerebellar artery, anterior inferior cerebellar artery, and superior cerebellar artery, thalamic stroke, cerebral hemisphere stroke, multiple sclerosis, and a cerebellar tumour. Additional oculomotor deficits did not reliably identify a central cause in these individuals, even with oculography. CONCLUSIONS We have identified a significant subpopulation of patients with acute vertigo in whom the current standard approaches such as the HINTS examination that focus on oculomotor assessment may not be applicable, highlighting the need for a formal assessment of gait in this setting.
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Affiliation(s)
- Sergio Carmona
- Fundación San Lucas para la Neurociencia, Rosario, Argentina
| | | | - Guillermo Zalazar
- Hospital de San Luis, Fundación San Lucas para la Neurociencia, Rosario, Argentina
| | - Nehzat Koohi
- Institute of Neurology, University College London, London, UK.,Ear Institute, University College London, London, UK
| | - Diego Kaski
- Institute of Neurology, University College London, London, UK
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Yao K, Zu HB. Isolated transient vertigo due to TIA: challenge for diagnosis and therapy. J Neurol 2023; 270:769-779. [PMID: 36371598 DOI: 10.1007/s00415-022-11443-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2022]
Abstract
As a prevalent vertigo disease in the clinic, isolated transient vertigo can present as a vertigo episode without focal signs and always free of symptoms on presentation. Previous studies showed a part of isolated transient vertigo events had a high risk of stroke during follow-up. However, how to discern posterior circulation ischemia become a great challenge for clinicians, especially in emergency, neurology, and ENT departments. Routine besides, hematological, and imaging examinations are often difficult provide a clear etiological diagnosis. Hence, this article reviews current knowledge about the epidemiology, risk factors, offending lesions, and clinical manifestation of transient ischemic attack (TIA) presenting as isolated transient vertigo. In addition, we summarize several advances in besides examinations, serum biomarkers, and imaging technologies to better identify stroke events. Finally, the current situation of therapy was briefly retrospected. Here we present a critical clinical puzzle that needs to be solved in the future. Of note, there is a still lack of high-quality studies in this field. The article reviews the keys to the diagnosis of isolated transient vertigo due to TIA and provides us with more methods to screen for high-risk stroke populations.
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Affiliation(s)
- Kai Yao
- Department of Neurology, Jinshan Hospital Affiliated to Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
| | - Heng-Bing Zu
- Department of Neurology, Jinshan Hospital Affiliated to Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
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8
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Rastall DP, Green K. Deep learning in acute vertigo diagnosis. J Neurol Sci 2022; 443:120454. [PMID: 36379134 DOI: 10.1016/j.jns.2022.120454] [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: 05/31/2022] [Revised: 09/24/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022]
Abstract
Recent advances in artificial intelligence are transforming healthcare and there are increasing efforts to apply these breakthroughs to the diagnosis of acute vertigo. Because the diagnosis of vertigo relies on the analysis of eye movements, there are several unique considerations that must be made when implementing deep learning approaches to vertigo. This review discusses the need for diagnostic aids for acute vertigo, the techniques used to preprocess eye movement data and adapt deep learning models to vertigo, and summarizes and analyzes all published models to date.
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Affiliation(s)
- David Pw Rastall
- The Johns Hopkins University School of Medicine, Department of Neurology, Division of Neuro-Visual & Vestibular Disorders, USA.
| | - Kemar Green
- The Johns Hopkins University School of Medicine, Department of Neurology, Division of Advanced Clinical Neurology, USA
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Mahmud M, Saad AR, Hadi Z, Elliot J, Prendergast M, Kwan J, Seemungal B. Prevalence of stroke in acute vertigo presentations: A UK tertiary stroke centre perspective. J Neurol Sci 2022; 442:120416. [PMID: 36115218 DOI: 10.1016/j.jns.2022.120416] [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: 05/06/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022]
Abstract
The reported prevalence of stroke amongst patients presenting to hospital with acute vertigo and/or imbalance is c. 5%, leading to the pervasive notion amongst emergency and stroke physicians, that stroke is uncommon in this cohort. To interrogate the veracity of this notion, we systematically and retrospectively screened the electronic care records in our institution of patients referred as suspected stroke, to a hyperacute stroke service at a large tertiary referral centre. We screened 24,310 consecutive patients' electronic case records presenting to our hospital as an emergency over a 4-month period, 332 of whom were referred as suspected stroke whose case records were assessed via structured review. Of these 332 cases, 61 presented with a vestibular syndrome, i.e. having at least one of imbalance, dizziness or vertigo. Of the 61 vestibular cases, 38 (62%) were diagnosed as stroke confirmed by imaging in 25/38 or upon clinical grounds only (13/38). None of the 38 vestibular stroke cases received thrombolysis or thrombectomy treatment. In a UK urban population (2.5mn), acute vestibular syndrome cases referred to stroke services have a 50% stroke prevalence. None of the vestibular stroke cases received hyperacute stroke treatment e.g., thrombolysis, due to delay in diagnosis. The high stroke prevalence in our cohort may indicate an excessively high threshold for referring acute vestibular cases for stroke, implying a high number of missed stroke cases. We suggest that early access to vestibular neurologists in acute vestibular cases should improve the proportion of vestibular stroke cases receiving definitive stroke treatment.
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Affiliation(s)
- Mohammad Mahmud
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London W6 8RF, UK.
| | - Abdel Rahman Saad
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London W6 8RF, UK
| | - Zaeem Hadi
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London W6 8RF, UK
| | - Jordan Elliot
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London W6 8RF, UK
| | - Mabel Prendergast
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London W6 8RF, UK
| | - Joseph Kwan
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London W6 8RF, UK
| | - Barry Seemungal
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London W6 8RF, UK.
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10
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Li B, Zhao Q, Du Y, Li X, Li Z, Meng X, Li C, Meng Z, Chen J, Liu C, Cao B, Chi S. Cerebral Blood Flow Velocity Modulation and Clinical Efficacy of Acupuncture for Posterior Circulation Infarction Vertigo: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:3740856. [PMID: 35800002 PMCID: PMC9256413 DOI: 10.1155/2022/3740856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 12/04/2022]
Abstract
Background Vertigo is a cardinal symptom of posterior circulation infarction (POCI). Acupuncture is demonstrated to have a beneficial effect on posterior circulation infarction vertigo (PCIV). However, the mechanism of acupuncture therapy is not clarified. This study aims to assess the cerebral blood flow velocity modulation and clinical efficacy of acupuncture for PCIV patients. Methods We conducted this systematic review for clinical randomized controlled trials (RCTs) regarding acupuncture on PCIV. The study duration was from September 2020 to September 2021. We searched the PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP. The publication date was set from inception to August 31, 2020. Based on the inclusion and exclusion criteria, two researchers independently screened literature and extracted data including basic study information, intervention details, outcome details, and adverse events. Outcome measures included the blood flow velocities of vertebrobasilar arteries and the Clinical Effective Rate of posterior circulation infarction vertigo. Pooled data were presented as standardized mean differences (SMDs) and relative risks (RR), with 95% confidence intervals (CIs). The meta-analysis was conducted using Review Manager software version 5.3.0. Results A total of 20 eligible RCTs (1541 participants) were included in this review, which compared acupuncture therapy (1 RCT) or acupuncture combined with pharmaceutical therapy (19 RCTs) to pharmaceutical therapy in patients with posterior circulation infarction vertigo. 7 studies assessed the blood flow velocities of the basilar artery examined by Transcranial Doppler (TCD), 8 studies assessed the bilateral vertebral arteries, and 13 studies evaluated the Clinical Effective Rate of posterior circulation infarction vertigo. Meta-analysis results showed that blood flow velocities of the basilar artery (SMD = 0.58, 95% CI = 0.40-0.76; P < 0.05), left vertebral artery (SMD = 0.48, 95% CI = 0.22-0.73; P < 0.05), and right vertebral artery (SMD = 0.44, 95% CI = 0.19-0.69; P < 0.05) were significantly higher in the acupuncture group compared with the control group. Clinical Effective Rate (RR = 1.22, 95% CI = 1.15-1.29; P = 0.792) was significantly better in the acupuncture group compared with the control group. Conclusions This study shows that acupuncture therapy is useful in improving the blood flow velocity of vertebrobasilar arteries and Clinical Effective Rate in patients with posterior circulation infarction vertigo. However, double-blind, sham-controlled trials with large sample sizes are required to support our conclusions.
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Affiliation(s)
- Boxuan Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road, No. 88, Xiqing District, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Changling Road, No. 88, Xiqing District, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Beihuanan Road, Jinghai District, Tianjin, China
| | - Qi Zhao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road, No. 88, Xiqing District, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Changling Road, No. 88, Xiqing District, Tianjin, China
| | - Yuzheng Du
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road, No. 88, Xiqing District, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Changling Road, No. 88, Xiqing District, Tianjin, China
| | - Xiayu Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road, No. 88, Xiqing District, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Changling Road, No. 88, Xiqing District, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Beihuanan Road, Jinghai District, Tianjin, China
| | - Zefang Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road, No. 88, Xiqing District, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Changling Road, No. 88, Xiqing District, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Beihuanan Road, Jinghai District, Tianjin, China
| | - Xianggang Meng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road, No. 88, Xiqing District, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Changling Road, No. 88, Xiqing District, Tianjin, China
| | - Chen Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road, No. 88, Xiqing District, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Changling Road, No. 88, Xiqing District, Tianjin, China
| | - Zhihong Meng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road, No. 88, Xiqing District, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Changling Road, No. 88, Xiqing District, Tianjin, China
| | - Junjie Chen
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road, No. 88, Xiqing District, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Changling Road, No. 88, Xiqing District, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Beihuanan Road, Jinghai District, Tianjin, China
| | - Chaoda Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road, No. 88, Xiqing District, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Changling Road, No. 88, Xiqing District, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Beihuanan Road, Jinghai District, Tianjin, China
| | - Beidi Cao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road, No. 88, Xiqing District, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Changling Road, No. 88, Xiqing District, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Beihuanan Road, Jinghai District, Tianjin, China
| | - Shihao Chi
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road, No. 88, Xiqing District, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Changling Road, No. 88, Xiqing District, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Beihuanan Road, Jinghai District, Tianjin, China
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11
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Kim JS, Newman-Toker DE, Kerber KA, Jahn K, Bertholon P, Waterston J, Lee H, Bisdorff A, Strupp M. Vascular vertigo and dizziness: Diagnostic criteria. J Vestib Res 2022; 32:205-222. [PMID: 35367974 PMCID: PMC9249306 DOI: 10.3233/ves-210169] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This paper presents diagnostic criteria for vascular vertigo and dizziness as formulated by the Committee for the Classification of Vestibular Disorders of the Bárány Society. The classification includes vertigo/dizziness due to stroke or transient ischemic attack as well as isolated labyrinthine infarction/hemorrhage, and vertebral artery compression syndrome. Vertigo and dizziness are among the most common symptoms of posterior circulation strokes. Vascular vertigo/dizziness may be acute and prolonged (≥24 hours) or transient (minutes to < 24 hours). Vascular vertigo/dizziness should be considered in patients who present with acute vestibular symptoms and additional central neurological symptoms and signs, including central HINTS signs (normal head-impulse test, direction-changing gaze-evoked nystagmus, or pronounced skew deviation), particularly in the presence of vascular risk factors. Isolated labyrinthine infarction does not have a confirmatory test, but should be considered in individuals at increased risk of stroke and can be presumed in cases of acute unilateral vestibular loss if accompanied or followed within 30 days by an ischemic stroke in the anterior inferior cerebellar artery territory. For diagnosis of vertebral artery compression syndrome, typical symptoms and signs in combination with imaging or sonographic documentation of vascular compromise are required.
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Affiliation(s)
- Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - David E Newman-Toker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kevin A Kerber
- Department of Neurology, University of Michigan Health System, Ann Arbor, USA
| | - Klaus Jahn
- Department of Neurology Schoen Clinic Bad Aibling and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | | | - John Waterston
- Monash Department of Neuroscience, Alfred Hospital, Melbourne, Australia
| | - Hyung Lee
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - Alexandre Bisdorff
- Department of Neurology, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
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Ibitoye RT, Mallas EJ, Bourke NJ, Kaski D, Bronstein AM, Sharp DJ. The human vestibular cortex: functional anatomy of OP2, its connectivity and the effect of vestibular disease. Cereb Cortex 2022; 33:567-582. [PMID: 35235642 PMCID: PMC9890474 DOI: 10.1093/cercor/bhac085] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 02/04/2023] Open
Abstract
Area OP2 in the posterior peri-sylvian cortex has been proposed to be the core human vestibular cortex. We investigated the functional anatomy of OP2 and adjacent areas (OP2+) using spatially constrained independent component analysis (ICA) of functional magnetic resonance imaging (fMRI) data from the Human Connectome Project. Ten ICA-derived subregions were identified. OP2+ responses to vestibular and visual motion were analyzed in 17 controls and 17 right-sided vestibular neuritis patients who had previously undergone caloric and optokinetic stimulation during fMRI. In controls, a posterior part of right OP2+ showed: (i) direction-selective responses to visual motion and (ii) activation during caloric stimulation that correlated positively with perceived self-motion, and negatively with visual dependence and peak slow-phase nystagmus velocity. Patients showed abnormal OP2+ activity, with an absence of visual or caloric activation of the healthy ear and no correlations with vertigo or visual dependence-despite normal slow-phase nystagmus responses to caloric stimulation. Activity in a lateral part of right OP2+ correlated with chronic visually induced dizziness in patients. In summary, distinct functional subregions of right OP2+ show strong connectivity to other vestibular areas and a profile of caloric and visual responses, suggesting a central role for vestibular function in health and disease.
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Affiliation(s)
- Richard T Ibitoye
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London W12 0NN, United Kingdom,Neuro-otology Unit, Department of Brain Sciences, Imperial College London, London W6 8RP, United Kingdom
| | - Emma-Jane Mallas
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London W12 0NN, United Kingdom,UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London W12 0BZ, United Kingdom
| | - Niall J Bourke
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London W12 0NN, United Kingdom
| | - Diego Kaski
- Department of Clinical and Motor Neurosciences, Centre for Vestibular and Behavioural Neurosciences, University College London, London WC1N 3BG, United Kingdom
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