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Unruptured Posterior Cerebral Artery Aneurysm Presenting with Temporal Lobe Epilepsy. Can J Neurol Sci 2020; 47:866-868. [PMID: 32460941 DOI: 10.1017/cjn.2020.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Singh V, Phadke R, Agarwal V, Behari S, Neyaz Z, Chauhan G. Posterior Cerebral Artery Aneurysms: Parent Vessel Occlusion Being a Viable Option in the Era of Flowdivertors. Neurol India 2020; 68:316-324. [DOI: 10.4103/0028-3886.280635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Satyarthee GD, Singh M. Giant Unruptured Middle Cerebral Artery Aneurysm Presenting with Complex Partial Seizure: A Short Review. J Pediatr Neurosci 2017; 12:185-187. [PMID: 28904583 PMCID: PMC5588650 DOI: 10.4103/jpn.jpn_182_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Intracranial aneurysm is a rare cause of seizure although few cases may develop new onset seizure following rupture of aneurysm. The causes of seizure in ruptured aneurysm may be caused due to presence of subarachnoid hemorrhage, intracerebral hematoma, infarct due to progressive vasospasm, worsening of hydrocephalus, or even after surgical craniotomy for clipping of aneurysm. However, incidental aneurysm solely presenting with complex partial seizure is not reported in literature. To the best of knowledge of authors, current case represents the first case as incidental aneurysm presenting with seizure and pertinent literature is briefly reviewed.
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Affiliation(s)
- Guru Dutta Satyarthee
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Kpelao E, Beketi KA, Ahanogbe KMH, Moumouni AK, Doleagbenou AK, Egu K, Ntimon B, Tchaou M, Egbohou P. Middle meningeal artery aneurysm: Case report. Surg Neurol Int 2017; 8:172. [PMID: 28840076 PMCID: PMC5551285 DOI: 10.4103/sni.sni_159_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/16/2017] [Indexed: 11/09/2022] Open
Abstract
Background: Aneurysms of meningeal middle artery (MMA) are extremely rare. These aneurysms are of two types: true aneurysm and pseudoaneurysm. The true type is usually seen with pathologic conditions. Pseudoaneurysms, on the other hand, are associated with a skull fracture. Epilepsy caused by MMA aneurysm has never been described to our knowledge. We report a case of true aneurysm isolated from MMA revealed by epilepsy. Case Description: A 57-year-old patient with a history of high blood pressure developed epilepsy which was treated by valproic acid. Initial scalp electroencephalography (EEG) showed seizure activity arising from the right temporal area. Epilepsy had become drug-resistant. Cerebral angiography revealed an aneurysm of the right middle meningeal artery without any other intraparenchymal anomaly. The interrogation did not reveal any history of family aneurysm. The patient underwent surgery with coagulation of the aneurysm and the MMA. The aneurysm was intradural in contact with the temporal cortex, and the surrounding brain tissues were preserved. The operative follow-up was favorable with amelioration of convulsions with a single antiepileptic. We planned to stop antiepileptic treatment according to electroencephalograms. Conclusions: Aneurysms of the MMA are rare. Their mode of revelation by seizures is unusual. The factors of rupture are not known. When isolated, their physiopathology is identical to that of the aneurysms of the Willis polygon. Their management uses the same techniques as for other cerebral aneurysms.
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Affiliation(s)
- E Kpelao
- Department of Neurosurgery, Sylvanus Olympio University Hospital Center, Togo
| | - K A Beketi
- Department of Neurosurgery, Sylvanus Olympio University Hospital Center, Togo
| | - K M H Ahanogbe
- Department of Neurosurgery, Sylvanus Olympio University Hospital Center, Togo
| | - A K Moumouni
- Department of Neurosurgery, Sylvanus Olympio University Hospital Center, Togo
| | - A K Doleagbenou
- Department of Neurosurgery, Sylvanus Olympio University Hospital Center, Togo
| | - K Egu
- Department of Neurosurgery, Sylvanus Olympio University Hospital Center, Togo
| | - B Ntimon
- Department of Radiology, Sylvanus Olympio University Hospital Center, Togo
| | - M Tchaou
- Department of Radiology, Sylvanus Olympio University Hospital Center, Togo
| | - P Egbohou
- Department of Intensive Care Unit, Sylvanus Olympio University Hospital Center, Togo
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Lin F, Wan H, Kang D, Lin Y. Small Unruptured Intracranial Aneurysm (≤5 mm) Associated with Epilepsy: Report of 2 Cases and Literature Review. World Neurosurg 2016; 98:878.e1-878.e6. [PMID: 27890748 DOI: 10.1016/j.wneu.2016.11.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/13/2016] [Accepted: 11/15/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Owing to the continuing improvements in imaging technology, an increasing number of epileptogenic small (≤5 mm) unruptured intracranial aneurysms (sUIAs) are being diagnosed. However, these sUIAs have not been systematically described and reviewed until now. CASE DESCRIPTION AND LITERATURE REVIEW We report 2 patients with sUIAs who initially presented with complex partial seizures. Scalp electroencephalography identified the seizure activity as arising from the mesial temporal/frontal areas, but conventional magnetic resonance imaging (MRI) was normal in both patients. The diagnosis of sUIA was achieved by cerebral angiography. One of the patients had idiopathic seizures and sustained a subarachnoid hemorrhage before the final diagnosis of sUIA. Both of the patients were treated by surgical clipping without resection of the adjacent discolored brain tissue, and the seizures were controlled after surgery. Furthermore, we thoroughly reviewed the relevant literature. We analyzed a total of 5 documented cases, including out 2 cases, and described the clinical characteristics, diagnosis, underlying mechanism, treatment, and prognosis of epileptogenic sUIA. CONCLUSIONS The seizures caused by sUIAs are most likely related to subclinical hemorrhages. Angiography may be helpful in identifying seizures associated with sUIA in patients with normal conventional MRI findings. For epileptogenic sUIA with normal preoperative MRI, clipping without damaging the surrounding brain tissue may be sufficient to resolve this complex issue.
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Affiliation(s)
- Fuxin Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, Fujian, China
| | - Hui Wan
- Department of Neurosurgery, The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Dezhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, Fujian, China
| | - Yuanxiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, Fujian, China.
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Walsh ME. The nose knows: an unusual presentation of a cerebral aneurysm. J Emerg Med 2014; 47:e113-5. [PMID: 25154559 DOI: 10.1016/j.jemermed.2014.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 05/10/2014] [Accepted: 06/30/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebral aneurysms most commonly present with subarachnoid hemorrhage (SAH), a catastrophic event. However, 11-15% of unruptured aneurysms are symptomatic, with presentations including seizures, unilateral cranial nerve deficits, visual loss, headache, and ischemia. Of patients presenting with seizures, the semiology described includes speech arrest, "feelings of dread," localized pins and needles, and tonic clonic episodes. We report the case of a patient who presented to the emergency department (ED) with complex partial seizures secondary to a cerebral aneurysm. CASE REPORT A 54-year-old woman presented to the ED after an episode where she had noticed a "bad smell" and sensations of nausea and dizziness. This was the third episode she had experienced in 2 weeks, and other than migraine, she had no significant medical or family history. Physical examination was normal, but a computed tomography (CT) scan of the brain revealed a 15-mm aneurysm of the right middle cerebral artery. The patient was subsequently transferred for urgent neurosurgical intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The emergency physician should strongly consider the use of head CT in the evaluation of adults presenting with a first unprovoked seizure, as rarely they can be caused by urgent pathologies including cerebral aneurysms. If a patient is found to have a possible symptomatic unruptured aneurysm, they should be referred for urgent neurosurgical consultation, as these lesions have an increased risk of rupture.
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Affiliation(s)
- Maia E Walsh
- Department of Emergency Medicine, Maidstone and Tunbridge Wells Trust, Tunbridge Wells, Kent, UK
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Lad SP, Shannon L, Byrne RW. Incidental aneurysms in temporal lobe epilepsy surgery: report of three cases and a review of the literature. Br J Neurosurg 2011; 26:69-74. [DOI: 10.3109/02688697.2011.601819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hänggi D, Winkler PA, Steiger HJ. Primary epileptogenic unruptured intracranial aneurysms: incidence and effect of treatment on epilepsy. Neurosurgery 2010; 66:1161-5. [PMID: 20495430 DOI: 10.1227/01.neu.0000369515.95351.2a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Seizures as the unique initial manifestation of unruptured intracranial aneurysms have rarely been documented and not systematically described until now. OBJECTIVE The purpose of this large retrospective analysis was to focus on the incidence of primary epileptogenic aneurysms and the influence of treatment on epilepsy. METHODS Within a 16-year period, 347 unruptured aneurysms were surgically treated at centers in Munich (1992-2002) and Düsseldorf (2003-2008), Germany. Of this patient population, 9 patients presented exclusively with epileptic seizures or epileptic equivalents. In 3 of them, a high-lying internal carotid artery aneurysm was diagnosed that was buried in the parahippocampal gyrus. In 4 patients, a middle cerebral artery aneurysm also created contact with the mediotemporal lobe adjacent to the parahippocampal gyrus. An anterior communicating artery aneurysm and a pericallosal artery aneurysm were diagnosed in 2 additional patients. Two patients with a middle cerebral artery aneurysm were initially incompletely occluded with Guglielmi detachable coils and continued to have epilepsy after the intervention. In all but 1 patient, the aneurysms were clipped and completely removed. RESULTS In all 8 patients operated on, there was no sign of hemorrhage intraoperatively but cortical gliosis was seen around the dome of the aneurysm. In all cases, the aneurysm and the surrounding gliosis, if existent, were surgically removed. Freedom from seizures without medication resulted for all patients after microsurgery. DISCUSSION Seizures as a presenting symptom of unruptured intracranial aneurysms are rare. There seems to be a preponderance of aneurysms anatomically related to the temporomedial region. Elimination of the aneurysm and perifocal gliosis provides the possibility of a cure for the epilepsy.
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Affiliation(s)
- Daniel Hänggi
- Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany.
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Ragel BT, Coon VC, Couldwell WT. Gustatory seizures and temporal lobe edema. J Clin Neurosci 2009. [DOI: 10.1016/j.jocn.2007.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Miele VJ, Bendok BR, Batjer HH. Unruptured aneurysm of the middle cerebral artery presenting with psychomotor seizures: case study and review of the literature. Epilepsy Behav 2004; 5:420-8. [PMID: 15145315 DOI: 10.1016/j.yebeh.2004.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2003] [Revised: 03/05/2004] [Accepted: 03/08/2004] [Indexed: 11/21/2022]
Abstract
An intracranial aneurysm would be low on the differential diagnosis of a patient presenting with behavioral or emotional changes. Nonetheless, complex partial seizures (CPS) may cause such symptoms and result from an unruptured intracranial aneurysm. Failure to diagnose and treat this condition in a timely manner increases the patient's risk of catastrophic aneurysmal rupture. This report describes a 55-year-old woman who presented following two CPS which began with the perception of a strange smell and culminated in a brief loss of consciousness. She had no history of seizure disorder or recent trauma. Magnetic resonance imaging (MRI) revealed a space-occupying lesion over the right temporal lobe near the amygdala. Magnetic resonance angiography (MRA) confirmed a 1.5-cm right middle cerebral artery aneurysm, with a dome projecting toward the amygdalohippocampal region. Following surgical ablation, the patient's CPS were well controlled. A review of the literature is performed on this unusual etiology and management strategies are discussed.
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Affiliation(s)
- Vincent J Miele
- Department of Neurological Surgery, West Virginia University School of Medicine, PO Box 9183, Morgantown, WV 26506-9183, USA.
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Honda M, Tsutsumi K, Yokoyama H, Yonekura M, Nagata I. Aneurysms of the Posterior Cerebral Artery: Retrospective Review of Surgical Treatment. Neurol Med Chir (Tokyo) 2004; 44:164-8; discussion 169. [PMID: 15185754 DOI: 10.2176/nmc.44.164] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A series of 10 cases of posterior cerebral artery (PCA) aneurysms were retrospectively reviewed. There were five men and five women aged 38 to 68 years (mean 57.5 years). Seven patients presented with subarachnoid hemorrhage. Two aneurysms were found incidentally during clinical examination for stroke. One aneurysm was associated with moyamoya disease. All aneurysms were saccular. The aneurysms arose from the P1 segment in three patients, the P1/P2 junction in three patients, the P2 segment in three patients, and the P3 segment in one patient. Two patients died before operation and one patient refused surgery. Aneurysmal clipping was performed for seven patients. All aneurysms except the P2 and the P3 aneurysms were treated via the pterional approach. Four patients had excellent outcome, but one patient with a P3 aneurysm developed homonymous hemianopsia due to thrombosis of the parent vessel and another patient with a P2 aneurysm had moderate disability from the initial insult. Coil embolization has been indicated as the first choice of therapy, but PCA aneurysms are good candidates for direct clipping.
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Affiliation(s)
- Masaru Honda
- Department of Neurosurgery, Nagasaki Rosai Hospital, Sasebo, Nagasaki, Japan.
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Abstract
Intracranial aneurysms have rarely been reported in association with complex partial seizures. We report five cases of complex partial seizures where aneurysms were found either accidentally or through investigations in these patients. MRI scans and angiograms revealed these aneurysms and in one patient several aneurysms were found. Four patients were treated with GDC coil embolisation with follow-on anti-epileptic medication. Two of the patients have reported a few minor seizures despite the treatment. The seizures in the other two patients have resolved completely after the treatment. The fifth patient is on anti-epileptic medication. We review the possible pathogenesis for the link between aneurysms and seizures. The treatment of intracranial aneurysms is also reviewed.
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Szajner M, Obsza Ska K, Nestorowicz A, Szczerbo-Trojanowska M, Trojanowski T. Endovascular treatment of giant p1/p2 aneurysm by direct puncture of the vertebral artery. Case report. Interv Neuroradiol 2003; 9:359-65. [PMID: 20591315 DOI: 10.1177/159101990300900405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2003] [Accepted: 10/10/2003] [Indexed: 11/16/2022] Open
Abstract
SUMMARY Vascular access is usually achieved through a femoral arterial puncture using a modified Seldinger technique. However, selective catheterization of the great cerebral vessels by femoral approach fails completely when the vessel is tortuous or atheromatous. In case of posterior vascular circulation aneurysms, transbrachial approach or direct puncture of the vertebral artery (VA) is an alternative. The aneurysms of the posterior cerebral artery (PCA) are reported to be rare. Due to unfavorable anatomic location, the PCA aneurysms are difficult to reach during surgical procedure. Endovascular embolization is at present considered to be more effective and safer treatment of the PCA aneurysms arising from different segments, offering a viable alternative to the surgical approach. We report the case of the giant left PCA aneurysm, located at the junction of P1/P2 segments, successfully treated by parent artery occlusion achieved after the direct puncture of the right VA which was used because both VAs were tortuous, irregular and their ostia were not accessible by femoral approach. According to different authors, parent artery occlusion appears to be safe in the treatment of P2 segment aneurysms, whatever the location of the occlusion. In our case we decided to perform this kind of treatment believing it was the only possible one.
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Affiliation(s)
- M Szajner
- Department of Interventional Radiology and Neuroradiology, University Medical School in Lublin; Poland -
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Sena JC, Reynier Y, Alliez B. Unruptured intracranial aneurysm presenting with epiletic seizure. ARQUIVOS DE NEURO-PSIQUIATRIA 2003; 61:663-7. [PMID: 14513177 DOI: 10.1590/s0004-282x2003000400026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intracranial aneurysms are frequently present with subarachnoid hemorrhage.Less often they produce suggestive symptoms of cranial nerve dysfunction or intracranial tumor when very large. Their association with epilepsy has rarely been reported; such concurrence may not be a coincidence. When the patient presents with epileptiforme attacks the presence of an intracranial aneurysm is rarely considered. In this paper we report the case of a 45-years-old patient with an unruptured aneurysm of the middle cerebral artery with a 10 years history of epileptic seizure.
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Affiliation(s)
- José C Sena
- Centre Hospitalier de la Côte Basque, Bayonne, France.
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Ellamushi H, Thorne L, Kitchen N. Unruptured cerebral aneurysms causing seizure disorder (report of two cases). Seizure 1999; 8:310-2. [PMID: 10486297 DOI: 10.1053/seiz.1999.0290] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Seizures as a presenting feature of unruptured cerebral aneurysm are unusual. We report two cases of unruptured cerebral aneurysm presented with seizures. In both cases the seizures controlled following surgical ablation of the aneurysm.
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Affiliation(s)
- H Ellamushi
- University Department of Neurosurgery, Institute of Neurology UCL, Queen Square, London, WC1 3BG, UK.
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Mizobuchi M, Ito N, Tanaka C, Sako K, Sumi Y, Sasaki T. Unidirectional olfactory hallucination associated with ipsilateral unruptured intracranial aneurysm. Epilepsia 1999; 40:516-9. [PMID: 10219282 DOI: 10.1111/j.1528-1157.1999.tb00751.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We describe a patient with complex partial seizure with unidirectional olfactory aura associated with ipsilateral unruptured aneurysm. METHODS AND RESULTS The patient felt a sweet pleasant smell coming from behind her right side every time before the attack. Cranial magnetic resonance imaging (MRI) and three-dimensional computed tomography (CT) angiography revealed a large aneurysm at the bifurcation of the right middle cerebral artery and compression of the right orbitofrontal cortex. Small spikes were recorded from the right orbitofrontal and superior temporal gyri and from the uncus by the cortical electrodes during clipping of the aneurysm. CONCLUSIONS The orbitofrontal cortex may have a function related to the ipsilateral directional olfactory sensation.
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Affiliation(s)
- M Mizobuchi
- Department of Neurology, Nakamura Memorial Hospital, Sapporo, Japan
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Affiliation(s)
- T J Ulahannan
- Department of Medicine, Kettering General Hospital NHS Trust, Kettering, UK
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