Often these patients have some form of cognitive impairment or developmental delay. Acad Radiol. T2 gradient echo or susceptibility weighted sequences are highly sensitive to detect blood products or calcifications and should therefore be part of a seizure imaging protocol (Fig. Being unprovoked, lesions that can irritate the brain (i.e., are epileptogenic) may be present. Hemosiderin is water-insoluble and thermally denatured, but ferritin is water-soluble and heat-resistant up to 75C. Superficial siderosis (SS) of the CNS is caused by repeated slow hemorrhage into the subarachnoid space with resultant hemosiderin deposition in the subpial layers of the brain and spinal cord. 2022 Dec 14;22(1):482. doi: 10.1186/s12883-022-03000-w. Kim E, Van Reet J, Kim HC, Kowsari K, Yoo SS. 10.2) will probably further increase the detection rate of epileptogenic substrates such as mesial temporal lobe sclerosis (MTS), focal cortical dysplasia (FCD), and polymicrogyria [811]. Correlation of lipoprotein-associated phospholipase A2 and cerebral microbleeds in patients with acute ischaemic stroke. In many cases, hemosiderin staining can be permanent. The blood pools under the skin. Imaging findings in patients with seizures include but are not restricted to: vascular conditions such as microangiopathy, previous ischemia, vascular malformations, previous hemorrhage or cavernomas, tumors (metastases, primary tumors), remote infections (encephalitis, abscess), previous head injury, congenital malformations, or toxic metabolic conditions. The third type of heterotopia is called periventricular nodular heterotopia or subependymal heterotopia. These capillary blood leaks can be caused by a number of things . (a) Axial T1IR; (b): sagittal T1. Patients with previous trauma can experience posttraumatic seizure disorder, especially after having sustained contusional hemorrhages of their temporal lobes as gliosis and hemosiderin staining can cause irritation of the surrounding cortex. The atrophy will lead to loss of the pes hippocampi interdigitations, widening of the temporal horn and atrophy of the white matter of the temporal lobe. We therefore only want to highlight few epilepsy-relevant facts and features of these miscellaneous conditions. Individual access to articles is available through the Add to Cart option on the article page. Summary of review: The findings shown are relatively subtle. [. What causes hemosiderin staining? ), and Department of Neurology, Division of Neuroradiology (K.L. Microbleeds in the Corpus Callosum in Anoxic Brain Injury. Radiologic and pathologic features of the transmantle sign in focal cortical dysplasia: the T1 signal is useful for differentiating subtypes. Hemosiderin is an iron-containing pigment that is formed from the hemoglobin of red blood cells that have disintegrated. 10.16). However, 0.4% of the general population will have recurrent and unprovoked seizures that do not respond to medication. MR contrast of ferritin and hemosiderin in the brain: comparison among gradient-echo . Submitted comments are subject to editing and editor review prior to posting. (e) patient 3, boy, 3months old, axial T1IR shows a region with thickened cortex in the right frontal lobe. 10.18). Excess iron is stored in your organs, especially your liver, heart and pancreas. This peculiar pattern can be explained by the vascular supply of the gyri in the newborn that leads to a better perfusion of the apices of the gyri as compared to the depth of the sulci. Excessive amounts of splenic hemosiderin are seen when erythropoiesis is . Imaging in the surgical treatment of epilepsy. MTS is characterized with extensive gliosis throughout the cornu ammonis (CA) regions, but early in the course of the disease there is loss of tissue in the stratum pyramidale most pronounced in CA1 region [15]. [, Sato N, Ota M, Yagishita A, Miki Y, et al. (a, b) Right lateral precentral gyrus type II FCD. If you have a subscription you may use the login form below to view the article. It is generally recommended that for an epilepsy-specific protocol T2FLAIR, T2/STIR in two parallel planes, T2 gradient echo/SWI sequences, and an isotropic 3D-T1 are necessary. The herniated brain demonstrates high T2/FLAIR signal and is believed to be the epileptogenic focus. Ippolito A, Urban H, Ghoroghi K, Rosbach N, Lingwal N, Adam EH, Friedrichson B, Steinbicker AU, Hattingen E, Wenger KJ. Your organization or institution (if applicable), e.g. (e, f) Diagnosis of ganglioglioma was confirmed following mesial sparing temporal lobectomy, Two patients with DNET. (6) It causes considerable lysis of red blood cells and removes much iron from hemosiderin. The blood pools under the skin and leave a residue of hemoglobin that settles in the tissue there. Hemosiderin staining typically does not go away without specific treatments, such as laser treatments and chemical peels. Thus, if females present with band heterotopias, genetic counseling may be indicated as half of their male offspring may be affected by anterior agyria. Neurosurg Focus. In adults, solid appearing ganglioglioma may mimic high grade glioma and advanced imaging techniques such as MR perfusion maybe a useful tool for pre-operative evaluation (Fig. What Causes Encephalomalacia? Access for 1 day (from the computer you are currently using) is US$ 39.00. The analysis of the BAL revealed an increased number of total cells, with an acute inflammatory reaction that resolved within 2 weeks. Malformations related to abnormal cortical organization encompass polymicrogyria, schizencephaly, and FCD type I (non-balloon cell). Dual pathology may consist also of bilateral mesiotemporal lobe sclerosis as one hemisphere may trigger the other hippocampus to become sclerotic thus constituting bilateral abnormalities. Thank you! ResultsMicrobleed prevalence gradually increased with age, from 6.5% in persons aged 45 to 50 years to 35.7% in participants of 80 years and older. Red meat can be a healthy part of a well-rounded diet if eaten in moderation. As pointed out by Wellmer et al. As the internal reference (i.e., the contralateral hippocampus) is similarly affected, comparison of the signal with other regions of archicortex (34 layered cortex) can identify whether a mesial temporal lobe sclerosis is present bilaterally. Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy. In the early vesicular, colloidal or granular nodular stages, the ictal focus is likely to originate from the cysticercus zone. Imaging evaluation should be standardized using a stepwise approach to evaluate the hippocampus and mesial temporal lobe structures, the ventricular outline, the gyral, and the sulcal anatomy. Hemosiderin staining is caused by an accumulation of iron in the tissues. Submissions must be < 200 words with < 5 references. Hemosiderin is a pigment formed when hemoglobin breaks down. In addition, patients may develop subependymal calcification as well as a subependymal giant cell astrocytoma; however, the latter two lesions are not believed to be epileptogenic. [, Strandberg M, Larsson EM, Backman S, et al. Hemosiderin and ferritin are iron-containing proteins with magnetic susceptibility. Results: Most women aged 2050 years consumed less dietary iron than their recommended dietary allowances. J Neurol Neurosurg Psychiatry. 10.21). In addition other conditions such as vascular malformations, certain phakomatoses, encephaloceles, or infections can be present. Pre-operative MRI (a, b) axial T2FLAIR and post gadolinium enhanced axial T1 images showed an avidly enhancing cortically based mass with moderate peri-lesional edema. The paramagnetic properties of blood degradation products make possible the visualization of MBs in vivo, using specific magnetic resonance imaging sequences. It's caused by blood leaking out of the tiny vessels called capillaries. It is often seen in people with chronic . 2019;40:10606. Imaging of choice in patients with epilepsy is MRI given the larger variety of potential underlying diseases. Patient 1. Note also hypertrophy (more). More recently a study by Kumura et al. AAN Members (800) 879-1960 or (612) 928-6000 (International) 10.19). CMBs are associated with subsequent hemorrhagic and ischemic stroke, and also with an increased risk of cognitive deterioration and dementia. (a) sag t2; (b) coronal T1. J Neurol Sci. Lines and paragraphs break automatically. Save my name, email, and website in this browser for the next time I comment. what causes hemosiderin staining in the brain. (more). Diagnostic methods and treatment options for focal cortical dysplasia. (a) axial and (b) coronal FLAIR images at standard window level setting as compared to narrowed window width setting of the same images in (c, d) which makes the lesion more conspicuous. The suitability of MR imaging to detect these findings varies between different sequences. In addition, callosal hypogenesis. If your child has Heiner syndrome, all milk and milk products should be removed from their diet. This susceptibility sensitive sequence shows the classical blooming artifact of the blood products within the cavernoma, Nodular calcified neurocysticercosis in the left hippocampus leading to acquired MTS. Cham (CH): Springer; 2020. (d, e) SWI and phase image show positive phase shift suggestive presence of calcification. A few unequivocal MHs in the splenium of the CC were found in one subject after severe acute mountain sickness, while one subject with high-altitude pulmonary edema and 2 of the extreme altitude climbers had questionable lesions. Hemosiderin is a particle representing an iron storage complex that is formed by the breakdown of hemoglobin or an abnormal metabolic pathway of ferritin. Do not be redundant. revealed that T1-weighted hyperintense transmantle sign is associated with higher density of balloon cells without significant differences in the number of dysmorphic neurons or the severity of gliosis (Fig. hawkstone country club membership fees; dragon age: origins urn of sacred ashes; rival 20 quart roaster oven replacement parts; shelby county today center tx warrants Brain. You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid You are important. It also increases the chance to detect subtle changessee small area with polymicrogyria in the left hemisphere! In addition, callosal hypogenesis. Clinically, patients present with macrocephaly, hemiplegia, developmental delay, and seizures. (c, d) The mother of the boy in (a, b) female carrier. Cortical dysplasias (coined type III) can be associated with a ganglioglioma. Notice the premature myelinization of the white matter tracts involved in the seizures, Left frontal type II FCD. Lacunar lesions are independently associated with disability and cognitive impairment in CADASIL. in 2013 [4, 5], the possible reasons for undetected epileptic lesions in standard outpatient MRI are insufficient clinical information from the referring clinician, routine MR protocols not optimized for the spectrum of epileptogenic lesions, and unfamiliarity with the spectrum of epileptogenic lesions. Methods: This was a cross-sectional study involving 37 mountaineers in 4 groups: 10 had . Microhemorrhages have been associated with older age, hypertension, smoking, white matter disease, lacunar infarcts, previous ischemic stroke, or ICH. Application of diffusion tensor imaging and tractography of the optic radiation in anterior temporal lobe resection for epilepsy: a systematic review. Brain AVMs can cause seizures due to previous hemorrhage and scarring, hemosiderin deposition (especially when close to the cortex), or gliosis. (a) coronal T2; (b) sagittal T1 with gadolinium; well delineated cortical/subcortical bubbly mass in the right frontal lobe with prolonged T2 and no contrast enhancement typical of a DNET. The increased signal stretches in to the temporal horn of the right ventricle; (b) coronal T1 with gadolinium. Did Texas Roadhouse change their chicken critters? (c) Patient 2, pancake view from a 3D T1-sequence gives a (more). (c, d) Despite the avid lesional enhancement, MR perfusion showed low rCBV value consistent with a low-grade glioma. The body then traps the released iron and stores it as hemosiderin in tissues. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Since hypertension was also found in all subjects who experienced stroke after presenting with MBs, such patients should be treated with, Cerebral microbleeds (MBs) are small chronic brain hemorrhages, likely caused by, Cerebral microbleeds (CMBs) are increasingly recognized neuroimaging findings, occurring with cerebrovascular disease, dementia, and aging. higgs-boson@gmail.com. Zhang X, Liu L, Jiang N, Liu Y, Wang Q, Tang X, Zhai Q, Zhao L. BMC Neurol. (c) T1 inversion recovery reveal (more). 2008;10:8392. [, Tllez-Zentenoa JF, Hernndez Ronquilloa L, Moien-Afshari F, et al. Taehan Yongsang Uihakhoe Chi. Proposal for a magnetic resonance imaging protocol for the detection of epileptogenic lesions at early outpatient stages. Hemosiderin often forms after bleeding (haemorrhage). (a, b) patient 1; (a) coronal T2 with large subcortical area in the right temporal lobe with prolonged T2. Web page addresses and e-mail addresses turn into links automatically. What causes hemosiderin staining? Microhemorrhages have been associated with older age, hypertension, smoking, white . Bookshelf Hemosiderin deposition in the brain is seen after bleeds from any source, including chronic subdural hemorrhage, cerebral arteriovenous malformations, cavernous hemangiomata. How long does it take to form hemosiderin? What does hemosiderin staining look like? (a) axial T2FLAIR with a small, cortical/subcortical, nodular high-signal area in the right parietal lobe close to the postcentral sulcus; (b) coronal T1 with gadolinium shows contrast enhancement in the nodulus, Right superior temporal gyrus ganglioglioma in a middle-aged patient. With the advent of modern MRI imaging techniques, cerebral microhemorrhages have been increasingly recognized on gradient-echo (GE) or T2*-weighted MRI sequences in different populations. This site needs JavaScript to work properly. Would you like email updates of new search results? To appreciate the importance of additional clinical information when evaluating the patient with medication refractory epilepsy. In normal animals, hemosiderin deposits are small and commonly inapparent without special stains. 2012;135:134869. Stains most often appear on the lower leg, sometimes covering the space between your knee and ankle. Hemosiderin is also generated from the abnormal metabolic pathway of ferritin.. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. Identification of the second focus is of great importance as failure to do so may result in surgical failure if only a selective amygdalohippocampectomy is performed thus leaving the primary focus behind. Gangliogliomas occur in young adults and older children, when present under the age of 10 they are often larger with more cystic components. In CAA, microhemorrhages predict both the risk of recurrent lobar ICH and future clinical decline. In patients with ischemic cerebrovascular disease, microhemorrhage number and location may be associated with executive dysfunction and may predict the occurrence of ICH and lacunar infarction. Most commonly encountered pathologies include mesial temporal lobe sclerosis (that can be uni- or bilateral and may occur as a dual pathology in conjunction with other epileptogenic lesions), malformations of cortical development (including disorders of neuronal proliferation, migration or organization) and epileptogenic tumors (such as gangliogliomas, dysembryoblastic neuroepithelial tumors). Your role and/or occupation, e.g. It's caused by blood leaking out of the tiny vessels called capillaries. When you are returned to the Journal, your name should appear at the top right of the page. These are similar in histology to the FCD type II and are therefore believed to be epileptogenic. 2013;105:34955. National Library of Medicine Following resection of the abnormal brain tissue seizure freedom can be obtained in a very large proportion of cases. (ac) Cavernoma in the right frontal lobe with an associated DVA. 10.17). Hemimegalencephaly. PMC (ac) Tuberous sclerosis; (a) axial T2 and (b) coronal T2FLAIR show subependymal hamartomas and widespread cortical and subcortical signal changes; (c) axial T1 with gadolinium with a large giant cell astrocytoma in a classical position, close (more), (ac) SturgeWeber syndrome; (a) axial CT shows curvilinear cortical calcifications in the right occipital lobe; (b) axial T1 without and (c) with gadolinium shows contrast enhancement caused by pial angiomatosis. Am J Neuroradiol. Cerebral microhemorrhages have been noted in healthy elderly, ischemic cerebrovascular disease, intracerebral hemorrhage (ICH), cerebral amyloid angiopathy (CAA), and in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. [, Howe KL, Dimitri D, Heyn C, et al. Hemosiderin is an insoluble form of tissue storage iron, being found at the level of different cells (not in the circulating blood). (a, b) axial and coronal FLAIR images demonstrate focal gyral thickening posteriorly in the left frontal gyrus with an associated curvilinear hypointense band following the bottom of the sulcus. Hsu CCT, Stenberg L, Krings T. Imaging the Patient with Epilepsy. Methods: This was a cross-sectional study involving 37 mountaineers in 4 groups: 10 had experienced HACE, 8 high-altitude pulmonary edema, 11 severe acute mountain sickness, and 8 had climbed to altitudes 6,962 m without developing any high-altitude illness. 2014;13:111426. Understanding the normal hippocampal internal architecture is critical to make the correct diagnosis. Cerebral amyloid angiopathy-associated intracerebral hemorrhage: pathology and management. What causes hemosiderin staining in the brain? (c, d) Patient 2: (c) sagittal T1; (d) coronal T2 FLAIR; This DNET in the left parietal lobe is associated with a FCD type II. Save my name, email, and website in this browser for the next time I comment. If the perinatal ischemia has only involved one hemisphere (perinatal stroke) a Dyke Davidoff Mason syndrome will ensue where stable hemiatrophy is present with hypertrophy of the skull and the sinuses, paucity of white matter, ventricular enlargement, and mild gliosis. Hemosiderin is a protein in blood that stores iron. there are no medical or medication issues. Clipboard, Search History, and several other advanced features are temporarily unavailable. Am J Neuroradiol. When cerebral microhemorrhages are diagnosed on MRI, conclusions regarding their significance and associated risks should be made based on the population examined. Excellent in plane resolution provides detailed imaging of hippocampus, Functional MRI. Treat the source of your symptoms. Pre-operative MRI (a, b) axial T2FLAIR and post gadolinium enhanced axial T1 images showed an avidly enhancing cortically based mass with moderate peri-lesional edema. Hemosiderin staining occurs when red blood cells are broken down, causing hemoglobin to be stored as hemosiderin. Depending on the location of the cavernous malformation in a person's nervous system, CCMs can also cause stroke-like symptoms. This susceptibility (more). MeSH government site. Laz Haque T, Miki Y, Kanagaki M, et al. In contrast to the other malformations of abnormal migration, the periventricular nodular heterotopia may exhibit quite mild symptoms with normal development and late onset of seizures. (c, d) Despite (more). Lesions that are often involved in medication refractory epilepsy are: mesial temporal lobe sclerosis (MTS) (primary or secondary to a long standing seizure disorder), malformations of cortical development, certain epileptogenic tumors (e.g., dysembryoplastic neuroepithelial tumors (DNET), temporal lobe gliomas gangliogliomas), vascular malformations, trauma, remote infection, and certain phakomatoses. Indistinct gray/white (more). Hemosiderin is a form of storage iron derived chiefly from the breakdown of erythrocytes, which normally takes place in the splenic red pulp. Abnormal gyration in the right hemisphere with a large region with polymicrogyria. Coronal sequences have to be angulated perpendicular to the hippocampal axis to allow hippocampal volume estimation and caution has to be taken that they are oriented in a plane that ensures direct comparison with the contralateral hemisphere. The longer you wait to seek treatment for your varicose veins, the more likely it is for the staining, or skin discoloration, to become permanent. Am J Neuroradiol. Epilepsia. Hemosiderin a protein compound that stores iron in your tissues can accumulate under your skin. Microbleeds are associated with subsequent hemorrhagic and ischemic stroke in healthy elderly individuals. Treatment for Hemosiderin Staining There are skin creams that can lighten dark spots, such as creams containing hydroquinone. 2008;29:8237. Distributing copies (electronic or otherwise) of the article is not allowed. The staining alone isnt life-threatening, but it can be an indication of a more serious condition. They are best visualized on T2 gradient echo or SWI sequences where they demonstrate with the classical blooming artifact (Fig. 10.13). Epub 2022 Aug 11. The blood pools under the skin and leave a residue of hemoglobin that settles in the tissue there. As such you may find vascular abnormalities (such as microangiopathy, arteriovenous malformations (AVM), sinus thrombosis, hemorrhage, cavernomas, or stroke), tumors (metastases, primary tumors), infections (encephalitis, meningitis, abscess), sequelae of previous head injury, and toxic or metabolic conditions (e.g., PRES) in these patients. Hemosiderin deposition in the brain as footprint of high-altitude cerebral edema. Lissencephaly with agyria more pronounced in the anterior part of the brain. (a, b) Ganglioglioma close to the right postcentral sulcus. Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here. [, Ryvlin P, Cross JH, Rheims S. Epilepsy surgery in children and adults. Theoretically, if the cavenous malformation and hemosiderin were located in or near the hypothalamus it's possible to cause hypothalamic dysfunction depending on its exact location with respect to the functional . How many calories are in a roll of spicy tuna? Epilepsy Res. Brain tissue can extend into the pterygopalatine fossa through the bony defect at the base of the greater sphenoid wing in the region of the foramen rotundum and pterygoid process. By using this Site you agree to the following, By using this Site you agree to the following, The Best IOL for 2022 RXSight Light Adjusted Lens, Will refractive surgery such as LASIK keep me out of glasses all my life, Acute Migraines Relieved By Beta Blocker Eye Drops, Alzheimer's Disease: Current Concepts & Future Directions, Causes of Headaches and Treatment for Headache Pain, New Gene Discoveries Shed Light on Alzheimer's. You must have updated your disclosures within six months: http://submit.neurology.org. Results: Most women aged 2050 years consumed less dietary iron than their recommended dietary allowances. Top differential diagnoses for DNETs are cortical dysplasia, ganglioglioma, pilocytic astrocytoma, glioma, neuroepithelial cysts, and dilated VR spaces. (c, d) The mother of the boy in (a, b) female carrier. Careers. Imaging findings of first-ever seizure patients are in most cases normal, and abnormalities are only present in approximately 15% of patients as seizures can be provoked by fever, sleep deprivation, stroboscopic lights, or drugs. Required fields are marked *. This discoloration is usually transient and disappears in a couple of weeks; however, in some people, the stain ends up being permanent. Patients experience seizures and a progressive hemiparesis. Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international) Results: Hemosiderin staining within alveolar macrophages was first detected in the BAL and lung tissue at day 3, peaked at day 7, and persisted through 2 months. For assistance, please contact: Semin Thromb Hemost. Patients with a thick band have less normal cortex (that can be thinned) and thus present with a more severe developmental delay. Neuroimaging in patients with refractory epilepsy will find abnormalities in as high as 85% of cases and therefore plays a crucial role in the identification of epileptogenic lesions and their possible surgical removal. Type II FCD is characterized on histology by dysmorphic neurons with or without balloon cells in addition to cortical dyslamination and are identical to cortical hamartomas in tuberous sclerosis. Lipofuscin or ceroid pigment also is normally present in macrophages scattered throughout the red pulp and can be demonstrated by acid-fast stains. If you are responding to a comment that was written about an article you originally authored: ), University Medicine, Gttingen, Germany. Epub 2020 Aug 3. Note that the signal is identical to that of cortex (more). Staining occurs as hemosiderin accumulates in our tissues, then deposits iron, which creates a reddish-brown or bruise-like appearance. Since hypertension was also found in all subjects who experienced stroke after presenting with MBs, such patients should be treated with intensive anti-hypertensive medication to prevent subsequent ischemic or hemorrhagic stroke. Objective: Based on recent findings of microhemorrhages (MHs) in the corpus callosum (CC) in 3 individuals after nonfatal high-altitude cerebral edema (HACE), we hypothesized that hemosiderin depositions in the brain after high-altitude exposure are specific for HACE and remain detectable over many years. Ultra-high-field MR neuroimaging. Results: Unequivocal MHs located in the splenium of the CC were found in 8 subjects and questionable MHs were found in 2 subjects 1 to 35 months after HACE. and transmitted securely. You will be redirected to a login page where you can log in with your AAN ID number and password. ways to boost your brainpower. Particular emphasis should be paid upon the T2/FLAIR signal within the cortex and hippocampus, its similarity to other regions of neo- and archicortex, the internal architecture of the hippocampus, the indentations of the pes hippocampi, the fornix and mammillary bodies, and the grey-white matter interface of the neocortex (blurring, gray matter thinning or thickening). Hemosiderin deposition in the brain is seen after bleeds from any source, including chronic subdural hemorrhage, cerebral arteriovenous malformations, cavernous hemangiomata. In the following we will discuss the imaging features of epileptogenic lesions highlighting imaging pearls and pitfalls. Hemosiderin or haemosiderin is an iron-storage complex that is composed of partially digested ferritin and lysosomes.The breakdown of heme gives rise to biliverdin and iron. Lancet Neurol. Interictal PET and ictal subtraction SPECT: sensitivity in the detection of seizure foci in patients with medically intractable epilepsy. Neonatal anoxic ischemia or hypoxemia can cause ulegyriai.e., a scar/defect of the cerebral cortex that mainly involves the cortex in the depth of the sulcus whereas the cortical crowns remain relatively unaffected. Gangliogliomas are cortically based, partly cystic tumors that may calcify and that harbor an enhancing nodule (Fig. Tuber cinereum hamartomas present with the combination of gelastic seizures and precocious puberty. Most affected individuals die within a decade after signs and symptoms first appear, although some people with the disease have survived longer. Viswanathan A, Gschwendtner A, Guichard JP, Buffon F, Cumurciuc R, O'Sullivan M, Holtmannsptter M, Pachai C, Bousser MG, Dichgans M, Chabriat H. Neurology. The analysis of the BAL revealed an increased number of total cells, with an acute inflammatory reaction that resolved within 2 weeks. 2016 Aug 15;367:89-94. doi: 10.1016/j.jns.2016.05.040.
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