Forty-six Cases of Vertebrobasilar Insufficiency Treated by Acupuncture plus Intravenous Infusion of Ligustrazine

Objective: To observe the therapeutic effect of acupuncture plus Ligustrazine on vertebrobasilar insufficiency (VBI) by transcranial Doppler (TCD) sonography. Methods: 86 VBI patients including 56 cases of low flow rate velocity type (LFVT) and 30 cases of high flow velocity type (HFVT) were randomly divided into Ligustrazine group (26 LFRT and 14 HFVT) and acupuncture plus Ligustrazine group (30 LFVT and 16 HFVT). The blood flow velocity (BFV) of vertebral artery (VA) and basilar artery (BA) in systole before and after treatment was measured with TCD and therapeutic effects were evaluated after 10 days’ treatment in the two groups. Results: In the acupuncture plus Ligustrazine group, the total effective rate was 93.3% and 88.5% in cases of LFVT and HFVT respectively, and BFV of VA and BA increased in LFVT patients while that in HFVT patients decreased significantly (P<0.05 or P<0.01). Conclusion: Owing to its dual regulation on blood flow of VA and BA, the therapeutic effect of acupuncture plus Ligustrazine was better than that of simple Ligustrazine.

Acupuncture Treatment of 42 Cases of Insufficient Blood Supply to Vertebrobasilar Artery

Insufficient blood supply to vertebrobasilarartery is one of the ischemic cerebrovascular diseasesencountered commonly and frequently in old people.Its clinical symptoms are capricious,and severeischemia may jeopardize the life of the patient.Thekey point for saving the patient's life and raising thequality of life is to relieve the symptoms and improveblood supply to the brain.From May 1995 to

Characteristics and utility of combined duplex color-coded ultrasonography in the cervical rotational position with head MRI and MRA in the differential diagnosis of apogeotropic direction-changing positional nystagmus

Objective:To determine whether cervical ultrasonography,magnetic resonance imaging(MRI),and magnetic resonance angiography(MRA)are useful in the differential diagnosis of etiology and understanding the pathophysiology in cases of apogeotropic direction-changing positional nystagmus(DCPN).Methods:Thirty patients with apogeotropic DCPN were classified into 11 cases of central disease,seven cases of mixed central and peripheral disease,and 12 cases of peripheral disease by differential diagnosis based on various balance function,neuro-otological,and imaging tests.Cervical ultrasonography using the cervical rotation method and MRI and MRA of the head and neck were performed in most patients with apogeotropic DCPN.We reviewed the presence of abnormal imaging findings according to the disease etiology.Results:Of the 30 patients with apogeotropic DCPN,23 showed vascular abnormalities or central lesions on imaging.Vascular lesions were found in six of the 12 patients with peripheral disease.Cervical ultrasonography with cervical rotation detected blood flow disturbance in the vertebral artery in eight patients in whom the disturbance could not be detected by MRI or MRA of the head and neck.Discussion:We hypothesize that the causative disease of apogeotropic DCPN may be strongly associated with circulatory insufficiency of the vertebrobasilar and carotid arteries,and that impaired blood flow in these vessels may affect peripheral vestibular and central function.In patients with apogeotropic DCPN,examinations of vestibular function,central nervous system symptoms,and brain hemodynamics are valuable for differential diagnosis.

Atypical case of bow hunter’s syndrome linked to aberrantly coursing vertebral artery: A case report

BACKGROUND In bow hunter’s syndrome(BHS),also known as rotational vertebral artery(VA)syndrome,there is dynamic/rotational compression of the VA producing verte-brobasilar insufficiency.Most occurrences involve atlantoaxial rather than mid-cervical VA compromise,the latter being rarely reported.Herein,we detail successful VA decompression at mid-cervical spine,given a departure from its usual course.CASE SUMMARY The patient,a 45-year-old man,presented to our hospital with occipital headache and vertigo.Computed tomography angiography showed anomalous C4 entry of right VA,with compression upon head rotation to that side.Thyroid cartilage and anterior tubercle of C5 transverse process were visibly at fault.We opted for sur-gery,using an anterior cervical approach to remove the anterior tubercle.Patient recovery was uneventful and brought resolution of all preoperative symptoms.CONCLUSION BHS is an important consideration where aberrant coursing of VA and neurologic symptoms coexist.

Angioplasty and stenting for severe vertebral artery orifice stenosis: effects on cerebellar function remodeling verified by blood oxygen level-dependent functional magnetic resonance imaging

Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic reso- nance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treat- ment only. The intervention group received vertebral artery orifice angioplasty and stenting ＋ identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.

Supplementing Qi and activating blood circulation method to treat vertebrobasilar dolichoectasia with posterior circulatory watershed infarction:a case report of two patients

Vertebrobasilar dolichoectasia(VBD),a rare posterior circulation vascular variant disease,is an important risk factor for many acute cerebrovascular diseases.An insufficient understanding of VBD often leads to misdiagnose.Two cases of VBD that were initially diagnosed as posterior circulation watershed infarction are reported here.Absence of common causes of stroke including hypoperfusion,blood system diseases,carotid and aortic dissection,and eosinophil elevation,the symptoms of the 2 patients met the diagnostic criteria of VBD.Both patients displayed symptoms that were in line with the Traditional Chinese Medicine(TCM)syndrome pattern of"Qi deficiency and blood stasis".Accordingly,they were comprehensively treated with Supplementing Qi and activating blood circulation method.The clinical manifestations of the 2 patients were remarkably improved and no recurrence of watershed infarction was found in a 1-year follow-up.A detailed medical history and laboratory examination are capable of improving diagnostic accuracy of VBD.TCM treatment based on syndrome identification might be a promising candidate for VBD management.

SELECTION OF ACUPOINTS BY DOPPLER SOUND SPECTROGRAM FOR TREATMENT OF INSUFFICIENT BLOOD SUPPLY OF CEREBRAL BASILAR ARTERY

Acupuncture moxibustion has been recognized to be effective for treatment of cerebral ischemia, but there are still some problems such as undefined criteria for evaluating the effectiveness and unchecked selection of acupoints. In the late 1980s, cerebrovascular examination was revolutionized in China

Long-term results of endovascular therapy for proximal subclavian arterial obstructive lesions

Background Endovascular therapy is a treatment option for localized occlusion of the subclavian artery. In this report the long-term experience with 59 patients is presented. Methods Between June 1998 and September 2008, we used endovascular therapy to treat 61 subclavian arterial obstructive lesions in 59 patients （46 males and 13 females, 34-82 years of age with a mean age （61.9~11.0） years）. Twenty patients （34%） had clinical symptoms due to vertebrobasilar insufficiency, 26 （44%） had disabling arm ischemia, and 13 （22%） had both symptoms. We performed all procedures under local anesthesia. The approaches were from the femoral artery （n=47）, brachial artery （n=-1, involving bilateral subclavian disease） or both （n=11）. Sixty stents were implanted. All patients were followed-up at 1,3, 6, and 12 months post-procedure, and annually thereafter. Results We achieved technical success in 58 （95.1%） arteries, all of which were stented. There were three technical failures; two were due to the inability to cross over an occlusion, necessitating the switch to an axillo-axillary bypass, and the third was due to shock after digital subtraction angiography and prior to stenting. Arterial stenosis pre- and post-stenting was （83.6±10.8）% and （2.5±12.5）% （P 〈0.01）. Clinical success was achieved in 55 of the 59 patients （93.4%）. Of the four clinical failures, three were technical and the remaining patient had a stent thrombosis. Systolic blood pressure difference between the two brachial arteries was （44.7±18.5） vs. （2.2±3.9） mmHg （P 〈0.01）. Primary patency was 98% at 12 months, 93% at 24 months, and 82% at 5 years. Five patients were lost to follow-up by 12 months post-stenting. Significant recurrent obstruction developed in five patients with resumption of clinical symptoms. The overall survival rate was 98.2% at 12 months, 89.5% at 24 months, and 84.5% at 5 years. Conclusions Endovascular therapy for proximal subclavian arterial obstructive lesions is effective and successful. This minimally invasive treatment may be the first choice of treatment for proximal subclavical arterial obstructive lesions.

Clinical observation on cervical chiropractic for cervical spondylosis of vertebral artery type

Objective：To observe the curative effect of cervical chiropractic for cervical spondylosis of vertebral artery type （CSA） and to explore its possible mechanism.Methods：Sixty CSA patients were randomly divided into two groups.Thirty patients in the treatment group were treated with chiropractic manipulation for cervical vertebrae,once every other day,7 treatments in total.The other 30 patients in the control group received oral administration of flunarizine hydrochloride,10 mg per night,for 14 d.Cervical vertigo and functional assessment scale and transcranial cerebral Doppler （TCD） were measured before treatment and 7 days after treatment.Results：The total effective rate was 96.7% in the treatment group and 83.3% in the control group.The curative rate was 66.7% in the treatment group and 20% in the control group.The differences between the two groups in the total effective rate and the curative rate were statistically significant （both P〈0.05）.The scores of cervical vertigo symptom and functional assessment after treatment in both groups were significantly higher than those before treatment （both P〈0.01）;the difference between the two groups was statistically significant （P〈0.05）.After treatment,the maximum systolic velocity （Vs）,the maximum diastolic velocity （Vd）,the mean velocity （Vm）,the pulsatility index （PI） and the vascular resistance index （RI） in both groups were significantly improved compared with those before the treatment （all P〈0.01）;there were significant differences between the two groups （all P〈0.05）.Conclusion：Cervical chiropractic is an effective method for CSA,and its curative effect is better than that of flunarizine hydrochloride alone.Its mechanism may relate to correcting cervical instability.

Therapeutic observation of acupuncture plus tuina for cervical vertigo

Objective:To evaluate the clinical efficacy of acupuncture plus tuina in treating cervical vertigo (CV).Methods:One hundred CV patients were randomized into an observation group and an acupuncture group by the random number table,with 50 cases in each group.The acupuncture group received acupuncture at Xiang Ba Zhen (eight acupoints on the nape);the observation group received tuina treatment in addition to the Xiang Ba Zhen acupuncture.The two groups were both treated once every other day for 10 sessions in total.The two groups were examined by transcranial cerebral Doppler (TCD) before and after the treatment,and their therapeutic efficacies were evaluated.Results:After the treatment,the mean velocity (Vm) of vertebral artery (VA) and basilar artery (BA) showed significant improvement in both groups (all P＜0.001);there were significant differences in the Vm of VA and BA between the two groups (both P＜0.05).The total effective rate was 100.0％ in the observation group versus 82.0％ in the acupuncture group,and the difference was statistically significant (P＜0.01).Conclusion:Xiang Ba Zhen acupuncture as a monotherapy or used together with tuina can improve CV,but Xiang Ba Zhen plus tuina can produce a more significant efficacy.

Treatment of 157 Cases of Cervical Spondylosis of Vertebral Artery Type by TuinaTherapy

Objective： To observe the clinical efficacy of tuina therapy in the treatment of cervical spondylosis of vertebral artery type. Methods： One hundred and tiffy-seven cases of cervical spondylosis of vertebral artery type were treated by tuina therapy, three times a week. Ten treatments made up one course and one to two courses of treatment was performed. During tuina treatment, other modalities that may affect tuina effects were discontinued. The patients were surveyed three months after tuina treatment. Results： Among the 157 cases, 109 cases obtained marked effectiveness, 26 cases improvement and 6 cases ineffectiveness; 16 cases were not surveyed. The total effective rate was 86.6%. Conclusion： Tuina therapy has excellent effects on cervical spondylosis of vertebral artery type.

Observation on Clinical Efficacy of Acupuncture Therapy for Posterior Circulation Ischemia Vertigo

Objective： To observe the clinical efficacy of acupuncture for posterior circulation ischemia vertigo （PCIV）. Methods： A total of 71 PCIV cases were randomly allocated into an acupuncture group （37 cases） and a medication （oral Flunarizine Hydrochloride） group （34 cases）. After 6 weeks of treatment, the therapeutic efficacies in the two groups were analyzed. Results： After treatment, the mean blood flow velocities （VM） of both the vertebral artery （VA） and the basilar artery （BA） in acupuncture group were significantly increased, showing statistical differences when compared with the pre-treatment result of the same group （P〈0.05）; despite some decrease in pulsatility index （PI） after treatment, there was no statistical difference when compared with the pre-treatment result. After treatment, the mean blood flow velocities of both VA and BA in the medication group were increased, showing statistical differences when compared with the pre-treatment result of the same group （P〈0.05）; there was no statistical difference in PI before and after the treatment （P〉0.05）. Regarding the improvement of VM, the acupuncture group was superior to the medication group, showing a statistical difference （P〈0.05）; there was no statistical difference in PI improvement between the two groups. Considering from the clinical efficacy, both acupuncture and medication are effective. However, acupuncture obtained a significantly better effect than medication （P〈0.05）. Conclusion： Acupuncture therapy can posterior circulation ischemia vertigo. obtain a better effect than oral Flunarizine Hydrochloride for