An aneurysm of the anterior cerebral artery segment A3 represents a rare yet dangerous subtype of intracranial aneurysms. The Pipeline Embolization Device with Shield Technology (PED shield) has been used to treat intracranial aneurysms. We report a case of a middle-aged patient who underwent PED Shield implantation and dense mesh stent-assisted embolization for an aneurysm, presenting with dizziness for 6 months that worsened over 1 day. Six-month postoperative follow-up revealed complete resolution of the aneurysm. This case demonstrates the favorable clinical outcome of PED Shield in treating an aneurysm of the A3 segment of the anterior cerebral artery, resulting in improved patient condition.

In Indonesia and Malaysia, women face disproportionate climate-related health impacts due to intersecting social, economic and environmental inequalities. Climate and health policies overlook these gendered vulnerabilities, highlighting the need for approaches that center women's lived experiences and priorities. This qualitative study identifies and ranks women's priority climate-related health risks. We conducted participatory focus group discussions with 35 women recruited via snowball and purposive sampling in Indonesia (n = 21) and Malaysia (n = 14), incorporating a structured ranking exercise informed by the Centres for Disease Control climate-health framework. A hand-coded thematic analysis approach was used. For Indonesian women, air pollution (e.g., respiratory issues) ranked highest, while for Malaysian women, extreme heat (e.g., leading to dizziness) ranked highest. Participants explained their reasons for contextualizing their rankings, such as living in urban or rural areas in Indonesia and Malaysia. These findings provide critical, nuanced insights into the urgent need to better consider gendered dimensions and to develop more gender-responsive climate policies that center the lived experiences of women regarding the climate-health nexus in Southeast Asia. As climate impacts intensify, ensuring that women's voices inform both national and international policy frameworks is not only a matter of equity but a prerequisite for effective and sustainable public health responses.

Cardiac sarcoidosis is an inflammatory heart disease that can cause conduction block, ventricular arrhythmias, and cardiomyopathy. Sustained monomorphic ventricular tachycardia is a high-risk presentation and may be the first sign of disease. A 69-year-old man with paroxysmal atrial fibrillation and chronic diastolic heart failure presented with palpitations, dizziness, and shortness of breath after a physical-therapy session. In the emergency department, he was found to be in atrial fibrillation with rapid ventricular response and frequent sustained runs of monomorphic ventricular tachycardia at rates >200 beats/min. Intravenous amiodarone was started. Echocardiography showed mildly reduced left ventricular ejection fraction (46%) and apical hypokinesis. Coronary angiography revealed only minimal nonobstructive coronary artery disease. Cardiac magnetic resonance imaging demonstrated mildly reduced left ventricular function (45%) and a nonischemic pattern of late gadolinium enhancement in the basal anteroseptal, basal inferoseptal, mid-inferoseptal, and inferior segments, highly suggestive of cardiac sarcoidosis. Endomyocardial biopsy was not pursued because of its low sensitivity and invasive risk, and the patient met contemporary criteria for "probable" cardiac sarcoidosis based on imaging and clinical findings. A targeted evaluation for extracardiac disease and infiltrative mimics was unremarkable. Further testing, including positron emission tomography, was planned as outpatient testing. He underwent implantation of a single-chamber implantable cardioverter-defibrillator for secondary prevention and was discharged in stable condition. This case highlights cardiac sarcoidosis as an important cause of sustained ventricular tachycardia in patients with non-ischemic scar on cardiac magnetic resonance and minimal coronary disease. Modern guidelines allow a working diagnosis without biopsy, relying instead on cardiac magnetic resonance and positron emission tomography.

A 66-year-old man with a history of 50 pack-years of cigarette use, hypertension, type 2 diabetes mellitus, OSA, and a left upper lobe lung nodule that had been stable on imaging for nearly 2 years presented with dizziness. His vital signs were within normal limits; the rest of the examination was notable for a bony protuberance from the vertex of the calvarium to the right side of the skull.

Since the first pacemaker implantation in 1958, cardiac pacing has transformed the management of bradyarrhythmias and conduction system disease. Despite major technological advances and the widespread use of dual-chamber and biventricular pacing systems, pacemaker therapy may be complicated by pacemaker syndrome, a clinical entity resulting primarily from atrioventricular (AV) dyssynchrony. Pacemaker syndrome is characterized by a constellation of cardiovascular and neurologic symptoms including fatigue, dyspnea, dizziness, hypotension, palpitations, and neck pulsations. Although initially associated with single-chamber ventricular pacing, it is now recognized that pacemaker syndrome can occur with any pacing modality when inappropriate timing between atrial and ventricular contractions exists. The underlying pathophysiology involves reduced ventricular preload, loss of atrial contribution to cardiac output, retrograde ventriculoatrial conduction, elevated atrial pressures, and abnormal baroreceptor and neurohormonal responses. These mechanisms lead to impaired hemodynamics and a wide spectrum of clinical manifestations, ranging from mild exercise intolerance to overt heart failure and syncope. The reported incidence varies widely, from 2% to 80%, depending on diagnostic criteria and pacing mode, with higher rates observed in ventricular-paced systems. Diagnosis is primarily clinical and requires correlation of symptoms with device function and cardiac rhythm through pacemaker interrogation and electrocardiography. Management focuses on restoring AV synchrony by device reprogramming or upgrading to dual-chamber pacing, along with guideline-directed therapy for associated ventricular dysfunction. Early recognition and intervention are essential, as untreated pacemaker syndrome may lead to persistent ventricular dysfunction, atrial arrhythmias, reduced quality of life, and increased morbidity.

This narrative review focuses on the epidemiologic, clinical, and molecular aspects of Meniere disease, comparing studies from European and East Asian populations. Meniere disease is a complex, heterogeneous, chronic disorder of the human inner ear characterized by recurrent episodes of spontaneous vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness.The overall prevalence of Meniere disease is generally between 0.05% and 0.2% among adults worldwide. In Europe and North America, the reported point prevalence is generally higher than in East Asia, at ∼50-200 per 100,000 adults, with a female-to-male ratio of around 1.5-2:1. This contrasts with a slightly higher Meniere disease female-to-male ratio in East Asian populations, based on Korean data (∼2.17:1). Epidemiological data and genetic studies from China and other East Asian countries remain limited, with a reportedly lower incidence of Meniere disease in Japan (∼17 per 100,000/year based on national hospital surveys). In terms of clinical aspects of Meniere disease, the core symptom spectrum does not differ substantially between European and East Asian patients. Interestingly, comorbidity patterns appear to differ, whereby European studies in Meniere disease report an association with migraine and autoimmunity, whereas in East Asian data, this association is less frequently observed. Conversely, allergies and systemic inflammatory responses mediated by Th2 or autoinflammation have been reported in both European and East Asian studies. Familial Meniere disease is more commonly observed in European than East Asian populations, suggesting that the genetic structure may contribute to its susceptibility. We summarize the commonalities and differences with respect to the clinical manifestations and treatment of Meniere disease. We propose that multinational research on the molecular diagnosis and treatment of Meniere disease will facilitate a better understanding of the condition and provide impetus for future research.

Lateral medullary syndrome is a collection of different neurological symptoms after ischemic/hemorrhagic insult to either the posterior inferior cerebellar artery/vertebral artery or rarely the anterior inferior cerebellar artery, causing infarction of ipsilateral cerebellum and posterolateral medulla (Tiedt and Weidauer, 2013). Dizziness, nausea, vertigo, vomiting, nystagmus, ataxia, dysphagia, hoarseness of voice, ptosis, and sensory impairment of face and body are typical. Here we report an unusual presentation of a 47-year-old female who was hypertensive and diabetic and who complained of vertigo, nausea, vomiting, slurring of speech, facial deviation toward the left, and loss of pain and temperature over the right side of the face and body without any difficulty in swallowing or nasal regurgitation. The patient was eventually diagnosed with left lateral medullary syndrome, drawing attention to the rare and unusual presentation of the same.

Using multiple statistical methods, this study investigated the core diagnostic information from the four diagnostic methods, the distribution patterns of syndrome elements, and their relationship with laboratory biochemical indicators in diabetic peripheral neuropathy(DPN). The aim is to deepen the understanding of the disease-symptom-syndrome relationship in DPN. A retrospective study was conducted on 1 420 inpatients diagnosed with DPN patients at the Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, from June 2014 and June 2023. Data mining techniques, including frequency statistics, association rule analysis, factor analysis, cluster analysis, and Bayesian network analysis, were applied to examine general patient information, TCM diagnostic data from the four diagnostic methods, and laboratory biochemical indicators. The core clinical manifestations in DPN patients were dry mouth, limb numbness, blurred vision, fatigue, thirst, and a thready pulse. Association rule analysis indicated Yin deficiency leading to blood stasis is the core pathogenesis. Factor analysis indicated that the disease location primarily involved the spleen, kidney, and liver, while main disease nature elements were Yin deficiency, Qi deficiency, and blood stasis, often complicated by concomitant phlegm turbidity, Yang deficiency, and essence depletion. Cluster analysis identified five syndrome patterns: Yin deficiency with blood stasis syndrome, Qi deficiency with blood stasis syndrome, Yang deficiency with cold aggregation syndrome, phlegm stasis obstructing collateral syndrome, and liver-kidney deficiency syndrome. Among these, Yin deficiency with blood stasis syndrome and Qi deficiency with blood stasis syndrome were the most prevalent. Bayesian network analysis revealed associations between abnormal fasting blood glucose(FBG) and symptoms such as chest tightness, palpitations, dizziness, insomnia, and constipation. Abnormal glycosylated hemoglobin(HbA1c) was associated with frequent urination, polyphagia, polydipsia, thirst and dry mouth. Abnormal total cholesterol(TC) was linked to emaciation, fear of cold and cold limbs, and a weak pulse. Abnormal serum creatinine(SCr) was associated with slow reaction, a wiry pulse, and limb pain. The distribution of TCM syndromes in DPN primarily involves Yin deficiency with blood stasis syndrome and Qi deficiency with blood stasis syndrome. The core pathogenesis is Yin deficiency leading to blood stasis, with the disease location in the spleen, kidney, and liver. The identified associations between FBG, HbA1c, TC, SCr and specific TCM syndromes provide an objective basis for the microscopic syndrome differentiation of DPN and its integrated diagnosis and treatment combining Chinese and western medicine.