title: Effect of ibudilast on the reciprocal inhibitory visual-vestibular interaction closely related to dizziness after cerebral ischemia.
abstract: BACKGROUND
  Many patients with chronic cerebrovascular diseases suffer dizziness. Our earlier findings suggested that prolonged terms of dizziness episodes may decrease the regional cerebral blood flow (CBF) in the occipital visual cortex via a remote effect from the vestibular cortex.
  
  
  METHODS
  We studied 9 patients who suffered episodes of dizziness since the onset of chronic cerebral ischemia. Their at-rest CBF was measured at entry into the study and approximately 3 months after the start of ibudilast therapy when all patients reported the resolution of dizziness.
  
  
  RESULTS
  After 3 months of ibudilast their at-rest CBF was significantly increased in the left occipital lobe (P = .02). CBF after acetazolamide (ACZ) loading was significantly increased in the bilateral occipital lobes (right, P = .049; left, P = .02) and in the bilateral parieto-insular vestibular cortex (PIVC; right and left, P = .02). There were no significant CBF changes in any other areas.
  
  
  CONCLUSIONS
  Our findings indicate that the occipital cortex and PIVC were implicated in their dizziness after cerebral ischemia. We discuss the underlying mechanism(s) and the relationship between dizziness and reciprocal inhibitory visual-vestibular interactions.
authors.affiliation: Division of Neurosurgery, Kumamoto Neurosurgical Hospital, Kumamoto, Japan. Electronic address: ninoue@knh.co.jp.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Inoue
authors.affiliation: Division of Neurosurgery, Kumamoto Neurosurgical Hospital, Kumamoto, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Fukuda
authors.affiliation: Division of Neurosurgery, Kumamoto Neurosurgical Hospital, Kumamoto, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Inada
authors.affiliation: Division of Neurosurgery, Kumamoto Neurosurgical Hospital, Kumamoto, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Sameshima
authors.affiliation: Division of Neurosurgery, Kumamoto Neurosurgical Hospital, Kumamoto, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Tokushima
authors.affiliation: Division of Neurosurgery, Kumamoto Neurosurgical Hospital, Kumamoto, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Harada
mesh_terms: D000086:Acetazolamide; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D003863:Depression / Q000523:psychology; D004232:Diuretics; D004244:Dizziness / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000098:blood supply / Q000187:drug effects; D011569:Psychiatric Status Rating Scales; D011725:Pyridines / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*; D014722:Vestibule, Labyrinth / Q000187:drug effects / Q000502:physiology*; D014785:Vision, Ocular / Q000187:drug effects / Q000502:physiology*; D014793:Visual Cortex / Q000502:physiology; D007212:Indolizines; D011720:Pyrazoles
chemical_list: D000086:Acetazolamide; D004232:Diuretics; D011725:Pyridines; D014665:Vasodilator Agents; C038366:ibudilast; D007212:Indolizines; D011720:Pyrazoles
keywords: Acetazolamide; cerebral blood flow; cerebral ischemia; dizziness; ibudilast; occipital lobe; parietoinsular vestibular cortex; phosphodiesterase inhibitor; vertigo; xenon-enhanced computed tomography