INTRODUCTION: We aimed to investigate the effect of physical therapy in patients with vertebrobasilar insufficiency syndrome (VBIS) secondary to cervical spondylosis.
METHODS: Fifty-five patients with VBIS were randomized as physical (32 patients) and medical therapy (23 patients). Physical therapy including infrared, cervical traction, ultrasound and TENS was applied to group 1. Group II received tenoxicam, paracetamol, phenprobamate, and pentoxifyllin for 15 days. The blood flow velocities (cBFV) of the vertebral and basilar arteries were recorded by transcranial Doppler ultrasonography (TCD). A four points scale was used to evaluate the intensity of symptoms due to vertigo (0= none, 1= mild, 2= moderate, 3= severe).
RESULTS: In group 1; cBFV in right and left VA, and in basilar artery increased significantly (p<0.01, p<0.05, and p<0.05, respectively). In group 2, no significant difference in cBFV was observed. When the groups were compared with each other, no significant diference was found. At the end of the treatment, a statistically significant improvement in the scores of subjective vertigo was observed in both groups (p<0.001, p<0.05). Comparison of the post-treatment scores for vertigo between the groups showed significant improvement in favor of the physical therapy group (p<0.05).

DISCUSSION AND CONCLUSION: Our results suggested that physical therapy might be a suitable alternative in the treatment of VBIS secondary to cervical spondylosis.

INTRODUCTION: Chlamydia pneumoniae is a human respiratory pathogen that causes acute respiratory disease and ~10% of community-acquired pneumonia. The infections are geographically widespread. In addition to respiratory disease, seroepidemiologic studies have shown an association of this organism with atherosclerotic proces and cerebrovascular disease. The role of preceding chlamydial infection as a risk factor for stroke was investigasted.
METHODS: We studied 68 consecutive patients under 65 years of age with cerebrovascular disease; the mean age was 52.08 ± 5.74 years (yrs) (range 39 yrs to 64 yrs; 28 female and 40 male) and 29 randomly selected age-matched healthy subjects (control); the mean age was 49.76 ± 13.11 years (yrs) (range 41 yrs to 62 yrs; 12 female and 17 male). Specific antibodies to C pneumoniae and C trachomatis in serum were measured by the microimmunofluorescence with the method of Wang and Grayston in all the subjects. Quantitative variables were analyzed with Mann-Whitney test.
RESULTS: The mean values of antibodies titers in patients (mean IgG antibodies to C pneumoniae in patients, 1.382 ± 0.256 vs. control, 1.152 ± 0.334 [p=.012], mean IgG antibodies to C trachomatis in patients, 0.043 ± 0.019 vs control, 0.031 ± 0.015 [p=.026]) were significantly higher compared with the controls. Although the mean IgM antibodies titers to C pneumoniae and C trachomatis are lower and IgA to C pneumoniae higher in patients than the controls, this differences were not found to be significant (mean IgM antibodies to C pneumoniae in patients, 0.502 ± 0.188 vs. control, 0.559 ± 0.149 [p=.087], mean IgM antibodies to C trachomatis in patients, 0.451 ± 0.348 vs. control, 0.683 ± 0.578 [p=.140], mean IgA antibodies to C pneumoniae in patients, 1.008 ± 0.246 vs. control, 0.971 ± 0.237 [p=.563]).
DISCUSSION AND CONCLUSION: We conclude that chronic infection with chlamydiae is associated with an increased risk of cerebrovascular disease and believe that patients who have high values of IgG antibodies titers should be warned for a probable cerebrovascular disease and other risk factors like smoking, alcohol, diet, etc.

Persistent primitive trigeminal artery (PPTA) is the most common persistent carotid and vertebrobasilar system anastomosis in adults. This pathology may be associated with other vascular abnormalities such as cerebral aneurysms. A case of ruptured anterior choroidal artery aneurysm associated with a PPTA is presented.

Essential thrombocytemia (ET) is clonal myeloproliferative disorders such as polycytemia vera, chronic myelogenous leukemia, and idiopathic myelofibrosis. It is characterized by thrombocytosis, thromboembolic events and mucocutaneous hemorrhage. Neurological symptoms include headache, vertigo, paresthesia, stroke, dysarthria, scintillating scotomas, syncope and even seizures. In this paper, we presented two patient with ET suffered from transient ischemic attack and discussed relation of ET and cerbrovascular disease.

Reversible posterior leukoencephalopathy syndrome (RPLS) is typically characterized by headache, altered mental functioning, seizures, and visual loss associated with imaging findings of bilateral subcortical and cortical eodema with a predominantly posterior distribution. A 24-year-old woman had delivered first baby at 40 weeks’ gestation. Her clinical course was stable until 2 days after delivery, when she developed attack of generalized tonic-clonic seizure, followed by decreased visual acuity and altered mental function. At 2 day after symptom onset, an MRI demostrated extensive, diffuse T2 hyperintense signal abnormalities involving subcortical white matter and adjacent and deep gray matter with a posterior predominance. We want to report this case that these clinical and radiologic findings were consistent with reversible posterior leukoencephalopathy syndrome, which has not been widely recognized.

The laser Doppler flowmetry is a method measuring continuously and real time blood flow in tissue. Laser Doppler flowmetry is used to measure the blood flow in both clinic and experimental applications in neurosurgery. In this technique is based on “Doppler principle”, a part of the laser light delivered to tissue back reflects from the dynamic structures, mainly red blood cells and this back reflected light, frequency of which shifted is received by detector and analyzed. In this article, the physical principles of the laser Doppler flowmetry and its applications in neurosurgery are reviewed.

The aim of this review is to asses the clinical, radiological and pathological properties of parkinsonism secondary to vascular reasons and to ascertain the signs that can help on the differential diagnosis. Although, for more than a century, the vascular pathology have been shown as an ethiological factor for parkinsonism, there is no enough data for accurate diagnosis. Usually, insidous progression at the onset, predominantly lower body involvement, gait difficulties, pyramidal signs with early postural instability, incontinance and dementia are the features that can be useful for the differential diagnosis. There is necessity for larger clinico-pathological studies that contains neuro-imaging properties.