Research progress on the effect of the combination of Jing acupoints bloodletting therapy and Sangzhi (Mori Ramulus) on shoulder-hand syndrome after stroke

Shoulder-hand syndrome(SHS)is one of the common complications of ischemic stroke.The pathogenesis is not completely clear and the therapeutic effects are not very satisfactory.As one of the Five-Shu acupoints(the general terms of acupoints that the twelve meridians are located below the elbow and knee of the body),Jing acupoints is distributed at the end of fingers and toes where the twelve meridians of the human body pass by,and has the functions of stimulating the meridians and dredging the channels and collaterals.For the effects of discharging neurons,promoting cerebral blood flow and improving the brain micro-circulation,Jing acupoints bloodletting therapy can effectively relieve the clinical symptoms of the patients with SHS after stroke.Sangzhi(Mori Ramulus),with the ability of dredging the meridian and relieving the pain,is also has certain treatment functions to the SHS.In clinical practice,the combination of Jing acupoints bloodletting and Sangzhi(Mori Ramulus)have been widely used in the treatment of various diseases,and in terms of their mechanism of action,the combined treatment has a positive effect on post-stroke SHS,but there are few reports on this.Therefore,it is worth affirming the efficacy of combined treatment of SHS after stroke.This article elaborates the theoretical basis of Jing acupoints bloodletting on SHS after stroke,and the research progress of Sangzhi(Mori Ramulus)in treating SHS after stroke,which provide the theoretical guidance for the combination.

Timeliness of the analgesic effect of superficial needling on shoulder-hand syndrome after stroke

Objective To observe the correlation between analgesic effect and duration of analgesic effect of superficial needling for shoulder pain of shoulderhand syndrome（SHS） after stroke, so as to screen the best time period of analgesia. Methods A total of 120 patients with SHS after stroke（stage I） were recruited and superficial needling therapy was applied. Two obvious tenderness points on the affected shoulder of patients were found out. The site 80–100 mm down each tenderness point was selected for superficial needling. Bimanual needling technique was applied after inserting needles. The surrounding of tenderness points was pinched and grasped by left hand above the needling, and the technique of green dragon swaying tail was applied by right hand. The needles at each acupoint were manipulated for3 min and retained for 30 min. The analgesic effect was evaluated dynamically by visual analogue scale（VAS） in 120 patients before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The analgesic effects at different time were statistically analyzed by generalized estimating equation. Results The mean values of VAS were 7.483, 3.950, 4.767, 5.917 and 7.217, respectively, before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The difference of analgesic effect at different time was statistically significant（P〈0.01）; the difference of analgesic effect of superficial needling in treatment of SHS after stroke was significant between immediately after treatment and 30 min after treatment（both P〈0.05）, while there was no significant difference between 1 h after treatment and 24 h after treatment（both P〈0.05）. Conclusion Analgesic effect of superficial needling for shoulder pain of SHS after stroke was different at different time points and decreased over time; analgesic effect was the most significant immediately after treatment and the optimal duration of analgesic effect was from immediately to 30 min after superficial needling therapy.

Muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting in the treatment of shoulder-hand syndrome after stroke

Objective To observe the effect of muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting in improving nail fold microcirculation in the patients with shoulder-hand syndrome(SHS)after stroke,and the effects on hemorrheology,calcitonin gene-related peptide(CGRP)and serum substance P(SP).Methods A total of 72 patients were randomized into an observation group and a control group by the random number table method,with 36 cases in each group.The control group was treated with physical rehabilitation training,and the observation group was treated with additional muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting treatment.The treatment course lasted for 4 weeks.After treatment,the clinical efficacy of the two groups was compared.The changes in shoulder-hand syndrome scale(SHSS),simplified Fugl-Meyer assessment-upper extremity(FMA-UE),visual analog scale(VAS),activities of daily living(ADL),traditional Chinese medicine(TCM)syndrome score,nail fold microcirculation hemorheology indictors[whole blood viscosity(high-shear,low-shear),hematocrit,erythrocyte sedimentation rate(ESR)],CGRP and SP levels were observed.Results The total effective rate in the observation group was 86.1%,higher than 63.9%in the control group(P<0.05).The overall curative effect in the observation group was better than that in the control group(P<0.05).After treatment,the scores of pain sensation,edema,external turn and rotation of the arm in SHSS,and the total score were significantly decreased in both groups(all P<0.05),and each score in the observation group was lower than that in the control group(all P<0.05).After treatment,the scores of VAS and TCM syndrome in both groups decreased significantly(all P<0.05),and the scores of FMA-UE and ADL increased significantly(all P<0.05).The scores of VAS and TCM syndrome in the observation group were lower than those in the control group(both P<0.05),and the scores of FMA-UE and ADL were higher than those in the control group(both P<0.05).After treatment,the whole blood viscosity(high-shear and low-shear)and hematocrit in both groups decreased obviously(all P<0.05),and ESR increased obviously(both P<0.05),and the whole blood viscosity(high-shear and low-shear)and hematocrit in the observation group were lower than those in the control group(all P<0.05),and ESR was higher than that in the control group(P<0.05).After treatment,the peritubular state,loop shape,blood flow and total score of nail fold microcirculation in both groups decreased significantly(all P<0.05),and each score in the observation group was lower than that in the control group(all P<0.05).After treatment,SP in both groups decreased obviously(both P<0.05),CGRP increased obviously(both P<0.05),and SP in the observation group was lower than that in the control group(P<0.05),CGRP was higher than that in the control group(P<0.05).Conclusion Compared with conventional physical rehabilitation training,muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting treatment can significantly reduce the clinical symptoms of SHS,promote the recovery of physical functions,improve the nail fold microcirculation and hemorrheology indictors,and regulate the serum cytokine levels such as CGRP and SP.

Sensory changes, C-and A-fiber function, and shoulder-hand syndrome in hemiplegic patients after stroke

BACKGROUND： Clinical diagnosis of various neurological disorders involving the sensory nerves depends primarily on subjective description, which cannot be quantitatively evaluated, and is also less reproducible and specific. Quantitative sensory testing methods can overcome these shortcomings and is currently used to identify the function of the C- and A-fibers. OBJECTIVE： To apply the quantitative sensory testing method for analyzing changes in temperature sensation, cryalgesia, thermalgesia, and vibration sense on the skin surface of hemiplegic patients with post-stroke shoulder-hand syndrome, and to analyze the relationship between these changes and shoulder-hand syndrome. DESIGN, TIME AND SETTING： A non-randomized, concurrent, control study was performed at the Clinic and Inpatient Department of the Third Xiangya Hospital, Central South University, between June 2000 and April 2001. PARTICIPANTS： Thirty post-stroke, hemiplegic patients were divided into shoulder-hand syndrome and control groups, according to whether patients exhibited shoulder-hand syndrome, with 15 patients in each group. METHODS： A TSA2001 quantitative sensory testing device （Medoc, Israel） was used for quantitative sensory testing. All sensory testing employed limits, testing temperature sense on the palm thenar eminence and vibration sense on the thumb metacarpal. Cold threshold was ≤ 28 ℃, warmth threshold was ≥ 36 ℃, cold-evoked pain threshold was ≤ 5 ℃, heat-evoked pain threshold was ≥ 51 ℃, vibration threshold was ≥ 5 μm/s; if a patient met one of these items, he/she was considered to be hypoanesthesia. MAIN OUTCOME MEASURES： Cold, warm, cold-evoked pain, heat-evoked pain and vibration threshold changes on skin from the paralyzed upper extremity was measured in the shoulder-hand syndrome and control groups. RESULTS： Incidence of sensory disability in the shoulder-hand syndrome group increased more significantly than in the control group （P 〈 0.05）, with the primary manifestations being decreased cold threshold （P 〈 0.05） and increased warmth threshold （P 〈 0.05）. The value differences between cold and cold-evoked pain thresholds, as well as between warmth and heat-evoked pain thresholds, decreased significantly in the shoulder-hand syndrome group （P 〈 0.05）. There were no significant differences between the two groups in cold-evoked pain, heat-evoked pain, or vibration thresholds. CONCLUSION： The primary manifestations of sensory impairment in hemiplegic patients with post-stroke shoulder-hand syndrome were displayed as thermohypesthesia and hyperalgesia. Functional impairments of nerve fibers that control pain and temperature sense may play an important role in the pathogenesis of post-stroke shoulder-hand syndrome.

Delphi and Analytic hierarchy process for the construction of a risk assessment index system for post-stroke shoulder-hand syndrome

Background:Shoulder-hand syndrome(SHS)is one of the common complications after stroke,which is difficult to cure once it occurs.Early risk identification is an effective measure to prevent and treat SHS,but there is no effective tool to assess the risk assessment of SHS.Objective:To develop a validated tool to assess the risk of SHS occurrence after stroke.Methods:This was an observational study with a 3-step process:(1)Literature review to establish initial indicators;(2)Application of a modified Delphi method for two rounds of correspondence,with final indicators obtained by modifying each round based on expert opinion;(3)Application of hierarchical analysis to determine the weights of each indicator.Results:The initial literature review constructed4 primary indicators and 24 secondary indicators;after the first round of Delphi,a total of 10 secondary indicators were deleted and 6 secondary indicators were added,and the final indicators included 3 primary indicators and 15 secondary indicators,and in the second round,consensus was reached;by AHP analysis,the highest weight was given to existing risk factors(0.5584),followed by relevant medical history(0.3196);lastly,demographic factors(0.1220),and the scores of other secondary indicators met the requirements.Conclusion:This study establishes and constructs a post-stroke SHS risk assessment tool,which provides a basis for early identification of SHS and early intervention.Meanwhile,this study provides a methodological reference for the development of other indicatorssets.

Vertebrobasilar artery dissection manifesting as Millard-Gubler syndrome in a young ischemic stroke patient: A case report

BACKGROUND Millard-Gubler syndrome(MGS) is caused by a lesion in the brainstem at the level of the facial nerve nucleus, and it is also a rare ventral pontine syndrome.Vertebrobasilar artery dissection(VAD) is an uncommon cause of ischemic stroke. To the best of our knowledge, this is the first case report on the coexistence of MGS and VAD in a young acute ischemic stroke patient.CASE SUMMARY We herein describe an unusual case of young acute ischemic stroke patient,presenting with acute right peripheral facial palsy, right abducens palsy, and contralateral hemihypesthesia, manifesting as MGS. After receiving dual antiplatelet therapy with aspirin and clopidogrel, as well as rosuvastatin, the patient recovered significantly. The high-resolution magnetic resonance imaging(MRI) indicated a diagnosis of VAD.CONCLUSION Our finding further demonstrated that high-resolution MRI is a useful technique to early detect underlying dissection in posterior circulation ischemic stroke.

Bayés syndrome and acute cardioembolic ischemic stroke

Bayés syndrome is an under-recognized clinical condition characterized by advanced interatrial block.Bayés syndrome is a subclinical disease that manifests electrocardiographically as a prolonged P wave duration>120 ms with biphasic morphology±in the inferior leads.The clinical relevance of Bayés syndrome lies in the fact that is a clear arrhythmological syndrome and has a strong association with supraventricular arrhythmias,particularly atypical atrial flutter and atrial fibrillation.Likewise,Bayés syndrome has been recently identified as a novel risk factor for non-lacunar cardioembolic ischemic stroke and vascular dementia.Advanced interatrial block can be a risk for embolic stroke due to its known sequelae of left atrial dilation,left atrial electromechanical dysfunction or atrial tachyarrhythmia(paroxysmal or persistent atrial fibrillation),conditions predisposing to thromboembolism.Bayés syndrome may be responsible for some of the unexplained ischemic strokes and shall be considered and investigated as a possible cause for cryptogenetic stroke.In summary,Bayés syndrome is a poorly recognized cardiac rhythm disorder with important cardiologic and neurologic implications.

Heat stroke induced cerebellar dysfunction:A “forgotten syndrome”

We report a case of heat stroke induced acute cerebellar dysfunction, a rare neurological disease characterized by gross cerebellar dysfunction with no acute radiographic changes, in a 61 years old ship captain presenting with slurred speech and gait ataxia. A systematic review of the literature on heat stroke induced cerebellar dysfunction was performed, with a focus on investigations, treatment and outcomes. After review of the literature and detailed patient investigation it was concluded that this patient suffered heat stroke at a temperature less than that quoted in the literature.

Hypereosinophilic syndrome presenting as acute ischemic stroke,myocardial infarction,and arterial involvement:A case report

BACKGROUND Simultaneous cerebral and myocardial infarction with arterial involvement has not been reported in hypereosinophilic syndrome(HES).Here,we report a patient with HES that was also associated with acute ischemic stroke,myocardial infarction,and arterial involvement of the left common carotid artery,vertebral arteries,posterior cerebral artery,and coronary artery.CASE SUMMARY A 64-year-old male patient was admitted with headache and right lower extremity weakness.Laboratory tests indicated eosinophilia.Brain magnetic resonance imaging(MRI)showed bilateral and multiple acute infarcts in the border zones.Electrocardiography revealed that T wave was inverted and that the concentration of troponin I was significantly elevated above normal levels.Cardiac echocardiography showed an ejection fraction of 69%with mitral and tricuspid mild regurgitation.Computed tomography angiography detected multiple and localized instances of mild stenosis in the left common carotid artery bifurcation,bilateral vertebral arteries(V5 segment),and the posterior cerebral artery(P2 segment).These were observed together with multiple non-calcified and mixed plaques as well as luminal stenosis in the left circumflex artery,left anterior descending artery,and right coronary artery.The patient was treated with oral methylprednisolone and clopidogrel,after which the absolute eosinophil count fell rapidly to a normal level.After one month,a second brain MRI showed a partial reduction in the size and number of the lesions.CONCLUSION HES can masquerade as ischemic stroke,myocardial infarction,and arterial vascular involvement.The patient reported here recovered very quickly when his eosinophil blood count returned to normal.Early diagnosis and rapid reduction of eosinophils may lead to a good prognosis.

Moyamoya syndrome may result from psoriasis: Four case reports

BACKGROUND Moyamoya syndrome(MMS)is a group of diseases that involves more than one underlying disease and is accompanied by moyamoya vascular phenomena.Psoriasis is a chronic immune skin disease closely linked to high blood pressure and heart disease.However,psoriasis-related MMS has not been reported.CASE SUMMARY We collected data on patients with stroke due to MMS between January 2017 and December 2019 and identified four cases of psoriasis.Case histories,imaging,and hematological data were collected.The average age of the initial stroke onset was 58.25±11.52 years;three cases of hemorrhagic and one case of ischemic stroke were included.The average duration from psoriasis confirmation to the initial MMS-mediated stroke onset was 17±3.56 years.All MMS-related stenoses involved the bilateral cerebral arteries:Suzuki grade III in one case,grade IV in two cases,and grade V in one case.Abnormally elevated plasma interleukin-6 levels were observed in four patients.Two patients had abnormally elevated immunoglobulin E levels,and two had thrombocytosis.All four patients received medication instead of surgery.With an average follow-up time of 2 years,two causing transient ischemic attacks occurred in two patients,and no hemorrhagic events occurred.CONCLUSION Psoriasis may be a potential risk factor for MMS.Patients with psoriasis should be screened for MMS when they present with neurological symptoms.

Ischemic Stroke Due to Paradoxical Embolism in a Patient with Patent Foramen Ovale, Bilateral Distal Deep Vein Thrombosis and Platypnea-Orthodeoxia Syndrome: A Case Report

Patent foramen ovale (PFO) is a common congenital cardiac defect. It is usually asymptomatic, but it can be associated with relevant clinical manifestations such as cryptogenic stroke and platypnea-orthodeoxia syndrome. We present the case of a patient with hemodynamically significant carotid artery stenosis who underwent endarterectomy for a transient ischemic attack (TIA). After surgery, the patient presented an ischemic stroke due to M2 occlusion treated with mechanical thrombectomy. During hospitalization, a distal bilateral deep vein thrombosis was found. The patient developed respiratory failure due to a massive right-to-left shunt through a large PFO (platypnea-orthodeoxia syndrome). These findings are consistent with the hypothesis that the TIA and the subsequential ischemic stroke were related to paradoxical embolism rather than atherothromboembolism. The aim of our case report is to raise awareness of the possible complications of such a common finding as PFO.

Pure motor stroke as the most frequent lacunar syndrome: A clinical update

Pure motor stroke(PMS), also known as pure motor hemiparesis, is the most common of any lacunar form(between one half and two thirds of cases, depending on the series). In an acute stroke registry, 733 patients presented a lacunar infarct and PMS accounted for 12.7%(n = 342) of all first-ever stroke patients and for 48% of all lacunar syndromes. The posterior limb of the internal capsule, corona radiata, and pons are the most frequent brain topographies. Infarcts in the mesencephalus or medullary pyramid have been exceptionally reported. This present update is focused on the clinical evidence and mechanisms underlying the relationship between PMS and different stroke etiologies.

SNAPC3 gene rs12093 polymorphism is significantly associated with ischemic stroke wind syndrome

Objective:To investigate whether The small nuclear RNA activating complex polypeptide 3(SNAPC3)gene rs12093 polymorphism is associated with ischemic stroke(IS)and Traditional Chinese Medicine(TCM)syndromes of IS.Methods:This study enrolled 774 patients with ischemic stroke(IS)and 793 normal controls.Massarray technology was used for genotyping.And genetic association analysis was estimated by PLINK program.Results:①SNAPC3 gene rs12093 polymorphism was significantly associated with the risk of ischemic stroke wind syndrome of IS[OR=0.76,95%CI(0.58-0.99),P=0.047 in dominant model)].②After adjusting age and gender,SNAPC3 gene rs12093 polymorphism and the score of ischemic stroke wind syndrome(Padj=0.037 in additive model;Padj=0.009 in recessive model),the correlation is statistically significant.③After adjusting age and gender,platelet(PLT)(Padj=0.024 in addiction model;Padj=0.039 in dominant model)and thrombin time(TT)(Padj=0.042 in dominant model)were significantly associated with rs12093 polymorphism in patients with ischemic stroke wind syndrome.Conclusion:SNAPC3 gene rs12093 polymorphism may affect the occurrence of ischemic stroke wind syndrome.

Klippel-Trenaunay-Weber syndrome with ischemic stroke:A case report

BACKGROUND Klippel-Trenaunay-Weber syndrome(KTWS)is a very rare syndrome that involves three conditions:Cutaneous hemangiomas,varicosities,and soft-tissue hypertrophy of the affected limb.There are few cases of ischemic infarction with KTWS.Here,we describe a case of KTWS with ischemic stroke.CASE SUMMARY A 43-year-old man was diagnosed with KTWS with ischemic stroke.His chief complaints were worsening weakness and spasticity in the right leg.These symptoms had been present for 1 year,but the patient did not receive comprehensive rehabilitation until he underwent a 3-week integrated inpatient rehabilitation program at our center.After the program,his muscle strength,walking ability,and exercise endurance improved.Although relatively rare,clinicians should consider the possibility of a thromboembolic event in KTWS patients.Integrated rehabilitation can help such patients to recover function.CONCLUSION In conclusion,although rare,patients with KTWS may experience central nervous system vascular malformations and accompanying stroke.It is necessary to investigate whether such patients have any neurological or comorbid abnormalities.Even in the subacute or chronic period after neurological insult,integrated rehabilitation programs can lead to structural and functional enhancement.

Medication rules in treating phlegm-heat syndrome of acute ischemic stroke based on data mining

Objective:To analyze the medication rule of Traditional Chinese Medicine(TMC)in treating acute ischemic stroke(AIS)with phlegm-heat syndrome based on date mining.Methods:All clinical studies of TMC treatment for phlegm heatexcess pattern stroke at acute stage were searched from SinoMed,CNKI,VIP,Wanfang,Pubmed.The retrieval time was from the establishment of each database to 27 April 2020.Establish database through"Ancient and Modern Medical record Cloud platform(V2.2.3)"software.SPSS20.0 and SPSS Modeler 18.0 software was used to explore clustering analysis and drug association rule analysis of high frequency drugs.Results:60 articles were finally included and 59 prescriptions were collected.The result shows that the commonly used drugs are mostly warm and cold,and the taste is mainly sweet and bitter.The main distribution of meridian tropism is stomach,liver and spleen.In these prescriptions,the frequently used drug pairs were“Trichosanthis fructus”,“Rhei radix et rhizoma”and so on.The association analysis results showed that“Arisaema cum bile-Rhei radix et rhizoma”had the highest correlation.The clustering analysis figured out 2 groups of the herbs.Conlusion:The TCM treatment of AIS should be based on the drugs of clearing heat,resolving phlegm and dredging viscera.Because most of these drugs are bitter and cold,we should pay attention to taking care of the spleen and stomach while expelling evil.

Clinical Research of Traditional Chinese Medicine Fumigation and Washing Combined with Rehabilitation Training in the Treatment of Post-Apoplexy Shoulder-Hand Syndrome

Objective:To observe the clinical effect of traditional Chinese medicine fumigation and washing combined with routine rehabilitation training on post-stroke shoulder and hand syndrome(SHS).Comparing and analysing the effects of this treatment on the living ability of patients with post-stroke shoulder and hand syndrome.Methods:Fifty patients with post-stroke SHS who met the inclusion criteria were divided into observation group and control group by random number table method with 25 cases in each group.Both groups were given post-stroke secondary prophylactic drugs,while the control group was given routine rehabilitation training,20-30 minutes at a time,once a day,5 days a week,4 weeks as a course of treatment.On the basis of treatment in the control group,the observation group was combined with traditional Chinese medicine fumigation and washing,decocted with water to extract 3,000-4,000 ml juice,and added into the medicine bath bucket to soak the affected limb for 30-40 minutes,once a day,5 days a week,4 weeks as a course of treatment.The changes of upper limb edema degree,Numeric Rating Scale(NRS)score,Barthel index(MBI)and Fugl-Meyer Rating(FMA)scores before and after treatment were observed between the two groups,and the differences of clinical efficacy between the two groups were compared.Results:After treatment,the total effective rate in observation group was significantly better than that in control group(P<0.05).After treatment,the degree in upper limb edema in the two groups was significantly reduced(P<0.05),NRS score was decreased(P<0.05).Barthel index and FMA score were significantly increased(P<0.05),and the degree of upper limb edema and NRS score in the observation group were significantly lower than those in the control group(P<0.05).Barthel index and FMA score were significantly higher than those in the control group(P<0.05).Conclusion:The combination of traditional Chinese medicine fuming and washing with rehabilitation training has a better therapeutic effect on SHS,and the clinical efficacy of the former is more significant than that of single rehabilitation training.In clinical application,the former shows low cost,simple and easy operation,high acceptance by patients,and is conducive to promotion and use.

Influenza vaccination in acute coronary syndromes patients in Thailand： the cost-effectiveness analysis of the prevention for cardiovascular events and pneumonia

Background Influenza vaccination has been clinically shown to reduce adverse cardiovascular outcomes in acute coronary syndrome （ACS） patients, but the economic perspectives can provide important data to make informed decisions. This study aimed to perform the economic evaluation of lifelong annual influenza vaccination for cardiovascular events and well-established pneumonia prevention. Methods Lifetime costs, life-expectancy, and quality-adjusted live years （QALYs） were estimated beyond one-year cycle length of a six-health states Markov model condition on whether a hospitalization for ACS, stroke, heart failure, pneumonia, no hospitalizations occurred, or death. The comparison of three age-groups of 40-49, 50-65, and 〉 65 years scenario was performed. Incremental cost-effectiveness ratio （ICER） and net monetary benefit （NMB） were presented as a societal perspective in 2016. The model robustness was determined by one-way and prob- abilistic sensitivity analyses. Results The influenza vaccination was cost-effective in all age-groups, by dominant ICERs （lower cost with higher effectiveness） which was completely lower than acceptable willingness-to-pay threshold of Thailand [160,000 THB （4,466.8 USD） per QALYs], with a great incremental value of NMB. Especially, the 50-year-old-and- above scenario was shown as the most benefit at 129,092 THB （3,603.9 USD） for each patient. Conclusions The annually additional influenza vaccination to standard treatment in ACS was cost-effective in all age-groups, which should be considered in clinical practice and health-policy making process.

Comprehensive classifications for the endovascular recanalization of vertebral artery stump syndrome

Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and distal conditions(PAD).Materials and methods:Data were retrospectively collected from patients who underwent endovascular thrombectomy(EVT)at the Stroke Center of the First Hospital of Jilin University between January 2016 and December2021.Among patients with acute ischemic stroke in the posterior circulation,those with acute occlusion of the intracranial arteries and occlusion at the origin of the vertebral artery confirmed by digital subtraction angiography were selected.The clinical data were summarized and analyzed.Results:Fifteen patients with VASS were enrolled in the study.The overall success rate of surgical recanalization was 80%.The successful proximal recanalization rate was 70.6%,and the recanalization rates for P1,P2,P3,and P4 were 100%,71.4%,50%,and 66.67%,respectively.The mean operation times for the A1 and A2 types were124 and 120 min,respectively.The successful distal recanalization rate was 91.7%,and the recanalization rates for types D1,D2,D3,and D4 were 100%,83.3%,100%,and 100%,respectively.Five patients experienced perioperative complications(incidence rate:33.3%).Distal embolism occurred in three patients(incidence rate:20%).No dissection or subarachnoid hemorrhage occurred in any patient.Conclusion:EVT is a technically feasible treatment for VASS,and comprehensive PAD classification can,to a certain extent,help initially estimate the difficulty of surgery and provide guidance for interventional procedures.

Olecranon Bursitis Causing Reflex Sympathetic Dystrophy Syndrome in a Hemiplegic Extremity

Olecranon bursitis is rarely seen in patients with stroke, but reflex sympathetic dystrophy syndrome is not. Here, we report a stroke case, which represented the clinical symptom of reflex sympathetic dystrophy syndrome after development of olecranon bursitis in few days, and describe his clinical association between both conditions. Sonographicpicture of the right elbow in this case is shown.

Case Report on Hiccup and Lateral Medullary Syndrome

The case study is aimed at providing a more thorough analysis of a case of lateral medullary syn-drome presented only with persistent hiccup after eating lunch the study hopes to generate an interest for further studies into the topic and focuses on abnormal unusual presentations of lateral medullary syndrome. Ethical committee has approved this case after taking consent from the patient and explaining to him the importance of the case in clinical practice.