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Silva AR, Santos M, Machado MJ, Moreira R, Alves JN, Machado C, Santos AF, Ferreira C, Maré R. Cerebral Venous Thrombosis Due to Overdrainage in a Patient With Normal Pressure Hydrocephalus: A Case Report. Cureus 2022; 14:e28721. [PMID: 36211110 PMCID: PMC9529017 DOI: 10.7759/cureus.28721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/05/2022] Open
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2
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Yokoya S, Oka H, Hino A. Cerebral venous thrombosis following spontaneous intracranial hypotension diagnosed by craniotomy: A case report and diagnostic pitfalls. Surg Neurol Int 2021; 12:367. [PMID: 34513134 PMCID: PMC8422431 DOI: 10.25259/sni_546_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cerebral vein and dural sinus thrombosis (CVT) is a rare but important complication of spontaneous intracranial hypotension (SIH). The diagnosis is difficult in cases lacking typical symptoms and typical imaging findings. Case Description: A 29-year-old male patient with a seizure attack was admitted to our hospital. Based on the head imaging findings, we misdiagnosed the patient with primary cerebral parenchymal lesion and performed an open biopsy. However, during the procedure, the patient was diagnosed with low cerebrospinal fluid pressure and cerebral cortical vein thrombosis. Conclusion: Thus, CVT due to SIH should be considered as a probable cause of secondary parenchymal lesions.
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Affiliation(s)
- Shigeomi Yokoya
- Department of Neurosurgery, Saiseikai Shiga Hospital, Ritto, Shiga, Japan
| | - Hideki Oka
- Department of Neurosurgery, Saiseikai Shiga Hospital, Ritto, Shiga, Japan
| | - Akihiko Hino
- Department of Neurosurgery, Saiseikai Shiga Hospital, Ritto, Shiga, Japan
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3
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Ferrante E, Trimboli M, Petrecca G, Allegrini F. Cerebral venous thrombosis in spontaneous intracranial hypotension: A report of 8 cases and review of the literature. J Neurol Sci 2021; 425:117467. [PMID: 33894614 DOI: 10.1016/j.jns.2021.117467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/30/2021] [Accepted: 04/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The occurrence of cerebral venous thrombosis (CVT) in patients with spontaneous intracranial hypotension (SIH) raises difficult practical questions regarding the management of the two conditions. The first-line therapy for CVT is anticoagulation (AC); however, its potential benefit in SIH/CVT patients, especially if complicated by subdural haematoma, must be carefully evaluated taking account of the intracranial haemorrhage risk. Venous system recanalization and good prognosis in SIH/CVT patients treated with epidural blood patch (EBP), the main treatment option for SIH, have been already described. METHODS We reviewed our cases of SIH complicated by CVT among a cohort of 445 SIH patients observed and treated during the last years. All published case reports and case series reporting patients with SIH and CVT were also ascertained and reviewed. RESULTS Eight (2%) out of 445 patients suffering with SIH, were also diagnosed with CVT. All patients observed had orthostatic headache, three of them experienced a change in their headache pattern over the SIH course. Six out of eight patients received both AC and EBP treatments. Two patients were treated using only AC or EBP. A bilateral subdural haematoma enlargement after 1 month of AC was observed in one case. Complete CVT recanalization after treatment was obtained in three patients, including two with multiple CVT at baseline; partial CVT recanalization was achieved in two patients. Three patients experienced no CVT recanalization. After 6-48 months' follow-up all patients were still asymptomatic. CONCLUSIONS The use of AC therapy should be weighed against the intracranial haemorrage risk and should be monitored carefully if initiated. Effective and prompt EBP, even without AC therapy, might lead to a good prognosis in selected cases.
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Affiliation(s)
- Enrico Ferrante
- Neurology Department, AOR San Carlo, Potenza (IT), Italy; Neurology Department, Alto Vicentino Hospital, AULSS 7 Pedemontana, Santorso (IT), Italy; Neurology Department, Niguarda Ca Granda Hospital, Milan (IT), Italy.
| | - Michele Trimboli
- Neurology Department, AOR San Carlo, Potenza (IT), Italy; Institute of Neurology Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro (IT), Italy.
| | | | - Francesco Allegrini
- Anesthesiology and Intensive Care Department, AOR San Carlo, Potenza (IT), Italy
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Ng S, Poulen G, Lonjon N, Boetto J, Le Corre M. Cerebral venous sinus thrombosis following post-neurosurgical intracranial hypotension: A case report and systematic review of the literature. Neurochirurgie 2021; 68:117-122. [PMID: 33667532 DOI: 10.1016/j.neuchi.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
Cerebral venous sinus thrombosis (CVST) following brain surgery is a feared complication, commonly described after direct injury to the sinus. However, distant CVST occurring away from the operative area are unexpected. Yet, there is a strong physio-pathological rational supporting the role of intracranial hypotension as a risk factor of CVST. Here, we report the case of a frontal arachnoid cyst depletion followed by an extensive contralateral CVST. Given the major prognostic consequences observed in this clinical illustration, we further investigated the hypothesis of intracranial hypotension as an etiology of CVST by carrying out a systematic review of the literature.
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Affiliation(s)
- S Ng
- Department of Neurosurgery, Montpellier University Medical Center, Montpellier, France.
| | - G Poulen
- Department of Neurosurgery, Montpellier University Medical Center, Montpellier, France
| | - N Lonjon
- Department of Neurosurgery, Montpellier University Medical Center, Montpellier, France
| | - J Boetto
- Department of Neurosurgery, Montpellier University Medical Center, Montpellier, France
| | - M Le Corre
- Department of Neurosurgery, Montpellier University Medical Center, Montpellier, France
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Yamamoto A, Hattammaru Y, Uezono S. Spontaneous intracranial hypotension associated with cerebral venous thrombosis detected by a sudden seizure: a case report. JA Clin Rep 2020; 6:59. [PMID: 32754800 PMCID: PMC7403223 DOI: 10.1186/s40981-020-00362-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/16/2020] [Indexed: 11/14/2022] Open
Abstract
Background Spontaneous intracranial hypotension (SIH) is rare but can lead to life-threatening complications including cerebral venous thrombosis (CVT). The concurrence of CVT and SIH raises questions regarding priority. Case presentation We present the case of a 52-year-old woman who developed sudden left-sided hemiparesis and generalized tonic-clonic seizures. She experienced progressive orthostatic headaches over the prior 2 weeks. Imaging showed thrombosis in the left transverse and sigmoid sinuses, bilateral subdural hematomas, and a cervicothoracic cerebrospinal fluid leak. Low molecular weight heparin was administered, but it was discontinued 2 days later due to subarachnoid hemorrhage. She was transferred to our hospital where an epidural blood patch was applied immediately, which resulted in complete symptom relief. Conclusion CVT is a rare complication of SIH that may result in devastating consequences. Treatment of SIH should be the primary focus. Prompt diagnosis and EBP application can result in a good outcome.
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Affiliation(s)
- Atsuko Yamamoto
- Division of Outpatient Pain Clinic, Department of Anesthesiology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Yoshiyasu Hattammaru
- Division of Outpatient Pain Clinic, Department of Anesthesiology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471, Japan.
| | - Shoichi Uezono
- Division of Outpatient Pain Clinic, Department of Anesthesiology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471, Japan
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Bond KM, Benson JC, Cutsforth-Gregory JK, Kim DK, Diehn FE, Carr CM. Spontaneous Intracranial Hypotension: Atypical Radiologic Appearances, Imaging Mimickers, and Clinical Look-Alikes. AJNR Am J Neuroradiol 2020; 41:1339-1347. [PMID: 32646948 DOI: 10.3174/ajnr.a6637] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/30/2020] [Indexed: 12/19/2022]
Abstract
Spontaneous intracranial hypotension is a condition characterized by low CSF volume secondary to leakage through a dural defect with no identifiable cause. Patients classically present with orthostatic headaches, but this symptom is not specific to spontaneous intracranial hypotension, and initial misdiagnosis is common. The most prominent features of spontaneous intracranial hypotension on intracranial MR imaging include "brain sag" and diffuse pachymeningeal enhancement, but these characteristics can be seen in several other conditions. Understanding the clinical and imaging features of spontaneous intracranial hypotension and its mimickers will lead to more prompt and accurate diagnoses. Here we discuss conditions that mimic the radiologic and clinical presentation of spontaneous intracranial hypotension as well as other disorders that CSF leaks can imitate.
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Affiliation(s)
- K M Bond
- From the Mayo Clinic School of Medicine (K.M.B.), Rochester, Minnesota
| | - J C Benson
- Departments of Radiology (J.C.B., D.K.K., F.E.D., C.M.C.)
| | | | - D K Kim
- Departments of Radiology (J.C.B., D.K.K., F.E.D., C.M.C.)
| | - F E Diehn
- Departments of Radiology (J.C.B., D.K.K., F.E.D., C.M.C.)
| | - C M Carr
- Departments of Radiology (J.C.B., D.K.K., F.E.D., C.M.C.)
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Zhang D, Wang J, Zhang Q, He F, Hu X. Cerebral Venous Thrombosis in Spontaneous Intracranial Hypotension: A Report on 4 Cases and a Review of the Literature. Headache 2018; 58:1244-1255. [PMID: 30238694 DOI: 10.1111/head.13413] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 06/30/2018] [Accepted: 07/01/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Spontaneous intracranial hypotension is a risk factor for cerebral venous thrombosis. The occurrence of cerebral venous thrombosis in patients with spontaneous intracranial hypotension raises difficult practical questions regarding the management of the 2 conditions. We reviewed our experience and the relevant literature to evaluate these related questions. METHODS We retrospectively studied the medical records and imaging studies of patients with spontaneous intracranial hypotension at a tertiary center from January 2007 through January 2017. The main search strategy was a literature review of journal articles in PubMed (1966 to January 2017). RESULTS Among 374 patients with spontaneous intracranial hypotension, 4 were also diagnosed with cerebral venous thrombosis. A literature review yielded an additional 31 cases, including 21 men and 14 women with a mean age of 40.6 years. Of the 35 patients, 8 (22.8%) patients received anticoagulation therapy and epidural blood patch. Nineteen (54.3%) patients were given anticoagulant only. Seven (20%) patients were treated with epidural blood patch only. One (2.9%) patient did not receive epidural blood patch or anticoagulation therapy. There is no difference in terms of age, sex, diagnosis interval, association with other complications, and prognosis between the first 3 groups. Of the 19 patients who received anticoagulation therapy, 4 patients (21.1%) had intracranial hemorrhage or hematoma enlargement after anticoagulation, and one of these 4 patients died following further intracranial hemorrhage. Of the 8 patients who received both anticoagulation and epidural blood patch, 1 patient (12.5%, P = 0.528) developed subdural hematoma after anticoagulation. Of the 5 cases had intracranial hemorrhage aggravation after anticoagulation, 4 were subdural hematoma occurrence or enlargement. CONCLUSION Cerebral venous thrombosis is a rare but important complication of spontaneous intracranial hypotension. The primary focus of treatment should be the treatment of intracranial hypotension. It could be possible that anticoagulation might increase the risk of intracranial hemorrhage in patients with spontaneous intracranial hypotension, although a firm conclusion could not be drawn based on the limited number of patients currently available. The use of anticoagulation therapy should be prudent and should be monitored carefully if initiated.
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Affiliation(s)
- Dan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, PR. China
| | - Jin Wang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, PR. China
| | - Qiaowei Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, PR. China
| | - Feifang He
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, PR. China
| | - Xingyue Hu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, PR. China
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Fujii N, Fujii H, Fujita A, Kim Y, Sugimoto H. Spontaneous intracranial hypotension complicated by cerebral venous thrombosis. Radiol Case Rep 2018; 13:834-838. [PMID: 29955241 PMCID: PMC6020096 DOI: 10.1016/j.radcr.2018.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/16/2018] [Accepted: 05/23/2018] [Indexed: 11/16/2022] Open
Abstract
Spontaneous intracranial hypotension (SIH) is a well-known cause of orthostatic headache. Although subdural fluid collection is a usual complication of SIH, SIH as a risk factor for cerebral venous thrombosis (CVT) is not well-known. There are several mechanisms that could contribute to the development of CVT in SIH. Herein, we report a case of a 33-year-old woman with SIH complicated by CVT. She was treated with anticoagulation but did not receive a blood patch for the SIH, because there was resolution of orthostatic headache with bed rest and sufficient hydration. Follow-up magnetic resonance imaging showed resolution of the findings of SIH and CVT. Patients with SIH should be closely observed for any change in the headache pattern, which might suggest the development of CVT.
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Affiliation(s)
- Nana Fujii
- Department of Radiology, Jichi Medical University, School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Hiroyuki Fujii
- Department of Radiology, Jichi Medical University, School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Akifumi Fujita
- Department of Radiology, Jichi Medical University, School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Younhee Kim
- Division of Neurology, Department of Internal Medicine, Jichi Medical University, School of Medicine, Shimotsuke, Tochigi 329-0498, Japan
| | - Hideharu Sugimoto
- Department of Radiology, Jichi Medical University, School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
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Rath S, Shaikh A, Narwal P, Gupta A. New-onset headaches secondary to spontaneous intracranial hypotension. BMJ Case Rep 2018; 2018:bcr-2018-224240. [DOI: 10.1136/bcr-2018-224240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Perry A, Graffeo CS, Brinjikji W, Copeland WR, Rabinstein AA, Link MJ. Spontaneous occult intracranial hypotension precipitating life-threatening cerebral venous thrombosis: case report. J Neurosurg Spine 2018; 28:669-678. [PMID: 29600909 DOI: 10.3171/2017.10.spine17806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spontaneous intracranial hypotension (SIH) is an uncommon headache etiology, typically attributable to an unprovoked occult spinal CSF leak. Although frequently benign, serious complications may occur, including cerebral venous thrombosis (CVT). The objective of this study was to examine a highly complicated case of CVT attributable to SIH as a lens for understanding the heterogeneous literature on this rare complication, and to provide useful, evidence-based, preliminary clinical recommendations. A 43-year-old man presented with 1 week of headache, dizziness, and nausea, which precipitously evolved to hemiplegia. CT venography confirmed CVT, and therapeutic heparin was initiated. He suffered a generalized seizure due to left parietal hemorrhage, which subsequently expanded. He developed signs of mass effect and herniation, heparin was discontinued, and he was taken to the operating room for clot evacuation and external ventricular drain placement. Intraoperatively, the dura was deflated, suggesting underlying SIH. Ventral T-1 CSF leak was identified, which failed multiple epidural blood patches and required primary repair. The patient ultimately made a complete recovery. Systematic review identified 29 publications describing 36 cases of SIH-associated CVT. Among 31 patients for whom long-term neurological outcome was reported, 25 (81%) recovered completely. Underlying coagulopathy/risk factors were identified in 11 patients (31%). CVT is a rare and potentially lethal sequela occurring in 2% of SIH cases. Awareness of the condition is poor, risking morbid complications. Evaluation and treatment should be directed toward identification and treatment of occult CSF leaks. Encouragingly, good neurological outcomes can be achieved through vigilant multidisciplinary neurosurgical and neurocritical care.
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Affiliation(s)
| | | | | | - William R Copeland
- 3Division of Neurosurgery, Department of Surgery, Tenwek Hospital, Bomet, Kenya
| | | | - Michael J Link
- Departments of1Neurologic Surgery.,5Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota; and
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Sinnaeve L, Vanopdenbosch L, Paemeleire K. Association of Cerebral Venous Thrombosis and Intracranial Hypotension: Review of 3 Cases. J Stroke Cerebrovasc Dis 2017. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Pérez Pérez A, Calvo Porqueras B, Porta Etessam J, Jorquera Moya M. Hipopresión de líquido cefalorraquídeo como causa de trombosis de una vena cortical. Neurologia 2016; 31:648-649. [DOI: 10.1016/j.nrl.2014.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 09/30/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022] Open
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Cerebral venous thrombosis in two patients with spontaneous intracranial hypotension. Case Rep Neurol Med 2014; 2014:528268. [PMID: 25525533 PMCID: PMC4265689 DOI: 10.1155/2014/528268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/28/2014] [Indexed: 01/03/2023] Open
Abstract
Although few patients with spontaneous intracranial hypotension develop cerebral venous thrombosis, the association between these two entities seems too common to be simply a coincidental finding. We describe two cases of spontaneous intracranial hypotension associated with cerebral venous thrombosis. In one case, extensive cerebral venous thrombosis involved the superior sagittal sinus and multiple cortical cerebral veins. In the other case, only a right frontoparietal cortical vein was involved. Several mechanisms could contribute to the development of cerebral venous thrombosis in spontaneous intracranial hypotension. When spontaneous intracranial hypotension and cerebral venous thrombosis occur together, it raises difficult practical questions about the treatment of these two conditions. In most reported cases, spontaneous intracranial hypotension was treated conservatively and cerebral venous thrombosis was treated with anticoagulation. However, we advocate aggressive treatment of the underlying cerebrospinal fluid leak.
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Suetterlin K, Borg N, Joy H, Lovett JK, Ghosh BCP. When is ‘idiopathic intracranial hypertension’ no longer idiopathic? Pract Neurol 2013; 14:102-6. [DOI: 10.1136/practneurol-2013-000680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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