BACKGROUND: Osteophyte caused by degenerative osteoarthropathy of the cervical vertebrae may compress the vertebral artery, resulting in vertebrobasilar insufficiency, especially when the patients' head postures change, making them adapt forced head position.OBJECTIVE: To investigate successively the relationship between the change of flow velocity of the posterior circulation and the symptom of vertebrobasilar insufficiency during various head postures with transcranial Doppler ultrasound.DESIGN: Randomized grouping controlled, auto-control observation.SETTING: Department of Neurology, Guangxi Minzu Hospital and Department of Neurology, First Hospital, Peking University.PARTICIPANTS: A total of 20 patients with vertebrobasilar insufficiency and 10 normal persons were enrolled from Department of Neurology,Guangxi Minzu Hospital between March 2003 and May 2004.METHODS: Regard blood flow velocity in natural position of anterior segment of posterior cerebral artery as baseline values. Blood flow velocity was compared at left rotation, right rotation, anterior inflexion and posterior inflexion. Symptoms of vertebrobasilar insufficiency were observed. The data were collected and compared in individuals, within group, and between groups.MAIN OUTCOME MEASURES: Blood flow velocity difference of various head postures in each group; Symptoms of vertebrobasilar insufficiency were observed.RESULTS:During monitoring, there were 9 cases complained of ischemic symptoms and 11 cases without symptoms. There was no significant difference in blood flow change of left rotation, right rotation and posterior inflexion in the normal control group with natural position. The reduction of flow velocity was significant in anterior inflexion (P ＜ 0.05 ), and none appeared clinical symptom. There was significant difference in reduction of blood flow at anterior inflexion and at natural position in patients with symptom (P ＜ 0.05), and there was significant difference in reduction of blood flow at posterior inflexion and natural position (P ＜ 0.001 ). There was significant difference in reduction of blood flow at left rotation and posterior inflexion in those without symptom during monitoring as compared with that at natural position (P ＜ 0.05 ).CONCLUSION: Continuously observing the blood flow in posterior cerebral artery at different head position can objectively assess the relationship between decrease of blood flow velocity of vertebral arteries induced by neck movements and clinical symptoms.

Objective To assess the clinical features,diagnosis,therapy and the prognosis of vertebral artery dissection presented as ischemie cerebral vascular disease.Methods Clinical and routine laboratory examinations were performed in all the 6 patients,who underwent brain DSA,MRI,MRA and cervical vascular duplex ultrasound examinations.They fulfilled at least 1 of 2 imaging criteria used to diagnose vertebral dissection.Results There was sudden neck pain or occipital headache in 4 of the 6 eases.Vertigo and (or) dizziness were the main onset symptoms for all the subjects.Two cases presented Wallenberg syndrome; Three had recent trauma to the neck.DSA showed occlusion or stenosis of the vertebral artery.MRI showed an crescent-shaped intramural hematoma.Cervical vascular duplex ultrasound revealed normal intima-media thickness and no carotid atheroscleretic plaque,and displayed significant stenosis or occlusion of the involved vertebral artery.The dissections were found in the extracranial segment of the vertebral artery in 5 cases.The follow up period for all patients was approximately 26 months.The anticoagulant therapy was administered to all subjects for a period ranging from 9 to 53 months.The modified Rankin Scale (mRS)improved significantly as compared to baselines in all except for one ease,the mRS were4,4,4,2,2,2 vs 4,3,2,1,0,1 (Z=-2.07,P=0.038).Conclusions Vertebral artery dissection has unique clinical features.Neuroimnging is useful in confirming the diagnosis.The occlusive lesion of the involved vertebral artery is reversible under long-term anticoagulant treatment.The prognosis is relatively positive.

Methods to assess cerebrovascular autoregulation are variable, including blood pressure-autoregulation and cerebrovascular motor reactivity. Evaluation of cerebrovascular autoregulation may be used to assess cerebral circulation reserve. It may predict the risk of ischemic cerebral vascular event, and may contribute to clinical therapy.

SUMMARY Here we report a case of cervical spondylosis misdiagnosed as cerebral infarction .The pa-tient was a 55-year-old man with a one-day history of weakness in his right extremities .Brain magnetic resonance imaging ( MRI) showed no acute abnormality , cerevical MRI showed that cervical spondylisis , C4/5 , C5/6 disc herniation , spinal canal stenosis and compression of the spinal cord .Then the patient was transferred to the Department of Orthopaedics and underwent surgical treatment of cervical spondylo -sis.Followed-up for six months , the weakness of his right extremities returned to normal .

Objective To discuss the optimal time of “early PCI” by analyzing clinical short-term outcome of PCI in non ST-segment elevation acute coronary syndromes (ACS). Methods We selected 150 non-ST segment elevation ACS patients who had received PCI from 24 h to 4 weeks after the symptoms occurred. They were devided into 3 groups ( h) according to the interval between outbreak and PCI therapy. The success rate of PCI, improved chest pain, alteration of TIMI flow grades, and the ratio of adverse cardiovascular events during and after the procedure were compared. Results No significant differences were found in the 3 groups of patients with respect to the success rate, improved chest pain, alteration of TIMI flow grade. But the ratio of adverse cardiovascular events during the procedure in the 72 h group. So the PCI during 24-72 h in non ST-segment elevation ACS is safe and economical.

Objective To explore the causes and possible treatment for subacute coronary stent thrombosis (SST) after percutaneous coronary interventions (PCI) in the races of Han, Uygur and Kazak in Xin Jiang Province. Methods The variables of hemodynamic, blood coagulation, lesions characteristics, the course of operation and relative treatment of 21 cases of different races (Han. Uygur and Kazak) were reviewed and underwent logistic regression analysis. Results The incidence of SST were higher in the Uygur and the Kazak people than that in the Han group after PCI (1.4% vs 0.47%; 5.4% vs 0.47%, P

Objective To study the association between sympathetic skin response (SSR) and diabetic neuropathy,and explore its use as the objective base for its early diagnosis. Methods The latencies and amplitudes of the initiation,waves N and P in SSR of the extremities in 80 diabetic patients and 30 healthy controls were determined using electrophysiological measurements. Results The latencies of the initiation,waves N and P of SSR test were prolonged significantly in the diabetic patients as compared to the controls ( P 0.05). All but two patients (97.5%) demonstrated abnormal SSR in at least one limb. Seven patients (8.8%) had no responses in SSR in both the feet and hands. The frequency of abnormality in the latency of initiation and waves N and P was 86.9%(139/160)in the upper limbs,and 89.4%(143/160)in the lower limbs. Conclusions The SSR can detect the early dysfunction of the small sympathetic fibers in diabetes millitus and may be a useful electrophysiologic testing for the early diagnosis of diabetic neuropathy.

ObjectiveTo determine the frequency of cerebral microembolism in patients with asymptomatic or symptomatic extracranial and intracranial arterial stenosis and to assess its relationship to the onset and course of ischemic stroke.MethodsTCD was used to monitor patients with extracranial and intracranial cerebral arterial stenosis. Double channel four-gated and power M-Mode were used to detect microembolic signals (MES). The recording time was 60 min and the number of MES was counted. Patients were divided into 2 groups as extracranial internal carotid artery (ICA) stenosis and middle cerebral artery (MCA) stenosis. Each group was divided into 3 subgroups as asymptomatic, acute ischemic stroke (<30 d) and old ischemic stroke (≥30 d).ResultsThe total number of monitored artery was 74 in 63 patients. In ICA stenosis with asymptom, old ischemic stroke and acute ischemic stroke, the frequency of MES was 0(0/10), 0(0/7), 33%(6/18) and the number of MES in acute ischemic stroke was 3, 9, 8, 10, 1, 40 (mean=11.8). In MCA stenosis with asymptom, old ischemic stroke and acute ischemic stroke, the frequency of MES was 14%(2/14), 14%(1/7), 39%(7/18) and the number of MES was 4 and 1 in asymptom, 1 in old ischemic stroke, 4, 1, 4, 15, 16, 1 and 29(mean=10) in acute ischemic stroke. In ICA stenosis, the difference between acute ischemic stroke and asymptom (P=0.013), between acute and old ischemic stroke (P=0.031) reached statistic significance.In MCA stenosis, there was no significant difference between acute ischemic stroke and asymptom (P=0.115), so as between acute and old ischemic stroke (P=0.214).ConclusionEmbolism was important in the mechanism of ischemic stroke due to extracranial and intracranial arterial stenosis. The closer to ischemic stroke onset, the higher the frequency and the number of MES. TCD monitor was helpful to study the pathogenesis of ischemic stroke due to extracranial and intracranial arterial stenosis and determine the treatment.

Objective To quantitatively analyze the palpebral fissure changes in the neostigrnine tests with videonystagmography.Methods Thirty-five patients with myasthenia gravis ( MG),21 non-MG patients and 23 healthy volunteers were intramuscular injected with neostigmine methylsulfate(0.02 mg/kg) and atropine(0.5 mg).The width of palpebral fissure was measured before and after the injection for one hour( once every 10 minutes).The differences of palpebral fissure width of each time point within each group and between groups were analyzed quantitatively with repetitive measure ANOVA.Results There was a significant difference of palpebral fissures (mm) width at different time points within the MG group( before the test:4.67 ± 1.87,after the test:10 min:0.88 ±0.96,20 min:1.49 ± 1.38,30 min:1.71 ± 1.53,40 min:1.77 ± 1.82,50 min:1.79 ± 1.52,60 min:1.62 ± 1.68 ; F =11.202,P =0.002).There were also significant changes of palpebral fissures width in the MG group compared to the non-MG group and the normal control group (F =15.569,P ＜ 0.01; F =15.104,P ＜ 0.01 ).There was alsostatistical significance in the rate of change between these groups.Receiver operating characteristic analytical procedure indicated that 1.17 mm or 17.5％ was of better diagnostic capability in the neostigmine test.Conclusions Measuring palpebral fissure width with videonystagmography could be seen as an objective and accurate method.A patient with palpebral fissure width higher than 1.17 mm or 17.5％ should be highly suspected as MG.

Objective To evaluate whether therapeutic ultrasound, applied alone or with urokinase, may have a thrombolytic effect on blood clots in vitro, and the other factors influencing the urokinase-mediated thrombolysis. Methods Experiments were carried out in an in vitro blood clot model.The blood clots were divided into four groups as physiological solution group(NS), urokinase group(UK),physiological solution plus ultrasound group(NS + US), urokinase group plus ultrasound group(UK + US).After intervention of one hour in static 37 ℃ water bath, each group of blood clots was weighed. After that,the weight loss and thrombolysis rate of the blood clots in each group were calculated. To observe the impact of the age of the blood clots on urokinase-mediated thrombolysis rate, the thrombolysis rate of eight time points 3, 4, 5, 6, 7, 8, 9, 10 hours was tested. The time was determined from the blood drawn from the body to the initiation of thrombolysis test. Results In terms of thrombolysis rate, there was significant difference between UK group and UK + US group(LSD-t 12. 1, P ＜ 0.01), with a thrombolysis rate 29. 3% ±8. 2% and 37. 5% ±7. 9%, respectively. However, the difference of thrombolysis rate between NS group and NS + US group with a thrombolysis rate 13. 4% ±4. 4% and 14. 5% ± 5.4%, respectively,was not statistically significant with a P value of 0. 08(LSD-t 1.8). The age of the blood clots had a negative correlation to the thrombolysis rate to some extent. Conclusion Therapeutic ultrasound has a significant effect on thrombolysis in combination with urokinase rather than used alone. To a certain extent,the thrombolysis rate decreases with the age of blood clot.