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Optic Nerve Ultrasound Evaluation in Children: A Review. Diagnostics (Basel) 2023; 13:diagnostics13030535. [PMID: 36766639 PMCID: PMC9914511 DOI: 10.3390/diagnostics13030535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Managing patients with neurocritical illness requires monitoring and treating elevated intracranial pressure (ICP), especially in cases in children. In terms of precise and real-time measurements, invasive ICP measurements are presently the gold standard for the initial diagnosis and follow-up ICP assessments. As a rapid and non-invasive way to detect elevated ICP, point-of-care ultrasonography (POCUS) of optic nerve sheath diameter (ONSD) has been proposed. The utility of bedside POCUS of ONSD to detect elevated ICP with excellent diagnostic test accuracy in adults has already been demonstrated. Nonetheless, data on the relationship between POCUS of ONSD and ICP in children are scarce. Therefore, the purpose of this review is to point out the most recent findings from the pediatric published literature and briefly discuss what was assessed with ONSD ultrasound examination, and also to describe and discuss the diagnostic procedures available for optic nerve ultrasound appraisal. A search of the medical databases PubMed and Scopus was carried out. The terms such as "ocular ultrasonography", "ICP assessment", "children", "point-of-care ultrasound", and "POCUS" were searched. In conclusion, the use of the standardized A-scan technique coupled with the B-scan technique should be suggested to provide data that are as accurate, precise, repeatable, and objective as possible.
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De Bernardo M, Vitiello L, De Luca M, La Marca A, Rosa N. Optic Nerve Changes Detected with Ocular Ultrasonography during Different Surgical Procedures: A Narrative Review. J Clin Med 2022; 11:jcm11185467. [PMID: 36143114 PMCID: PMC9500847 DOI: 10.3390/jcm11185467] [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: 08/22/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Ultrasonographic appraisal of the optic nerve sheath diameter has become popular in recent years as a useful diagnostic tool to detect intracranial pressure variations. Intracranial hypertension is a life-threatening disease with possible poor clinical outcomes and can be caused by a variety of neurological and non-neurological conditions. Considering the latter, increases in intracranial pressure have also been described during several surgical procedures. Ocular ultrasonography might be utilized to identify intracranial pressure increases by evaluating optic nerve sheath diameter variations. The aim of this review is to provide a wide overview on the use of the optic nerve ultrasound evaluation to detect intracranial pressure changes during surgical procedures, also discussing the pitfalls of the B-scan technique, the most widely used for such a purpose. PubMed medical database, Web of Science and Scopus were used to carry out this review. The present review showed that ocular ultrasonography could be considered a valuable diagnostic tool in the surgical setting to indirectly assess intracranial pressure. However, the use of the B-scan ultrasound should always be coupled with the standardized A-scan technique for a more accurate, precise and trustworthy ultrasound assessment.
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Optic Nerve Drusen Evaluation: A Comparison between Ultrasound and OCT. J Clin Med 2022; 11:jcm11133715. [PMID: 35806999 PMCID: PMC9267746 DOI: 10.3390/jcm11133715] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023] Open
Abstract
This observational study compared optic coherence tomography (OCT) and B-scan in the detection of optic disc drusen. In total, 86 eyes of 50 patients with optic disc drusen (ODD) (36 bilateral) with a mean age of 34.68 ± 23.81 years, and 54 eyes of 27 patients with papilledema, with a mean age of 35.42 years ± 17.47, were examined. Patients with ODD, diagnosed with ultrasound, underwent spectral-domain OCT evaluation. With US, 28 ODD cases were classified as large (4 buried and 24 superficial), 58 were classified as point-like (6 buried, 49 superficial and 3 mixed). Then, all patients underwent OCT. OCT was able to detect the presence of ODD and/or peripapillary hyperreflective ovoid mass structure (PHOMS) in 69 eyes (p < 0.001). In particular, 7 eyes (8.14%) showed the presence of ODD alone, 25 eyes (29.07%) showed only PHOMS and 37 eyes (43.02%) showed ODD and PHOMS. In 17 eyes (19.77%) no ODD or PHOMS were detected. In the papilledema group, no ODD were observed with both US and OCT. OCT showed the presence of drusen or similar lesions in only 80.23% of the cases highlighted by the US scan, so it does not allow for certain ODD diagnoses, especially in the case of buried ODD.
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D'Aniello E, Stasi MD, Reda L. Letter: Evaluation of peripapillary - macular microvascularity and choroidal vascularity index after refractive surgery. Photodiagnosis Photodyn Ther 2022; 38:102833. [PMID: 35341981 DOI: 10.1016/j.pdpdt.2022.102833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Eleonora D'Aniello
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy.
| | - Margherita Di Stasi
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Ludovica Reda
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
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De Bernardo M, Vitiello L, De Pascale I, Capasso L, Cornetta P, Rosa N. Optic Nerve Ultrasound Evaluation in Idiopathic Intracranial Hypertension. Front Med (Lausanne) 2022; 9:845554. [PMID: 35299843 PMCID: PMC8921495 DOI: 10.3389/fmed.2022.845554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/28/2022] [Indexed: 01/27/2023] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a disease with a heterogeneity of possible causes, which needs to be quickly diagnosed. Ocular ultrasonography could be considered a useful tool to diagnose this condition in a fast and non-invasive way. In fact, Karl Ossoinig had already proposed this diagnostic tool in the 1970s for the evaluation of intracranial pressure changes under several pathological conditions, including idiopathic intracranial hypertension. The aim of this review is to analyze scientific articles published in the last 30 years concerning the use of ocular ultrasonography to assess optic nerve indices in patients with idiopathic intracranial hypertension. Specifically, 15 published articles found in PubMed database were included and analyzed in the present review. Our conclusion suggests that ocular ultrasonography is a reliable diagnostic technique to be utilized in all the cases of suspected raised intracranial pressure. To obtain the best possible accuracy and precision in the least invasive way, standardized A-scan seems to be the best choice.
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Affiliation(s)
- Maddalena De Bernardo
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana, " University of Salerno, Salerno, Italy
| | - Livio Vitiello
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana, " University of Salerno, Salerno, Italy
| | - Ilaria De Pascale
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana, " University of Salerno, Salerno, Italy
| | - Luigi Capasso
- Corneal Transplant Unit, Azienda Sanitaria Locale Napoli 1, Naples, Italy
| | - Palmiro Cornetta
- Eye Unit, "Maria SS Addolorata" Hospital, Azienda Sanitaria Locale Salerno, Salerno, Italy
| | - Nicola Rosa
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana, " University of Salerno, Salerno, Italy
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Sitanaya SN, Kamayanti F, Nugroho HA, Prabowo B. Comparing ultrasonographic optic nerve sheath diameter to head computed tomography scan to predict intracranial pressure elevation. SAGE Open Med 2022; 10:20503121221077834. [PMID: 35198210 PMCID: PMC8859652 DOI: 10.1177/20503121221077834] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Intracranial hypertension is an emergency condition that needs to be recognized as soon as possible. Lumbar puncture, the gold standard diagnostic procedure for intracranial hypertension, is contraindicated in some conditions while brain imaging procedures may be too difficult to be performed on critically ill patients. To solve this problem, this study aims to assess an alternative method to detect intracranial hypertension by measuring optic nerve sheath diameter using ocular ultrasound and optic nerve sheath diameter difference in each etiology. Methods: This cross-sectional study was conducted at the Emergency Department of Dr Iskak Tulungagung General Hospital. Sixty-nine patients who visited the emergency room for the first onset of intracranial pathology were included for optic nerve sheath diameter measurement by ultrasound. Subjects were divided into elevated and non-elevated intracranial pressure groups based on head computed tomography scan findings. The optic nerve sheath diameter results were compared and analyzed. Result: There were 29 subjects in the elevated intracranial pressure group and 40 subjects in the non-elevated intracranial pressure group. The mean of optic nerve sheath diameter in the elevated and non-elevated intracranial pressure groups was 0.63 ± 0.06 and 0.57 ± 0.06 cm, respectively (p = 0.000). Based on receiver operating characteristics analysis, 0.58 cm was the most optimal cut-off value. Conclusion: Ultrasonographic optic nerve sheath diameter can be used to predict elevated intracranial pressure in suspected patients who are contraindicated to invasive intracranial pressure measurement or critically ill. There were significant differences between elevated and non-elevated intracranial pressure groups in stroke and trauma subjects.
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Affiliation(s)
| | - Fadhila Kamayanti
- Emergency Department, Dr. Iskak Tulungagung General Hospital, Tulungagung, East Java, Indonesia
| | - Hari Adityo Nugroho
- Emergency Department, Dr. Iskak Tulungagung General Hospital, Tulungagung, East Java, Indonesia
| | - Bobi Prabowo
- Emergency Department, Dr. Iskak Tulungagung General Hospital, Tulungagung, East Java, Indonesia
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Vitiello L, De Bernardo M, Capasso L, Cornetta P, Rosa N. Optic Nerve Ultrasound Evaluation in Animals and Normal Subjects. Front Med (Lausanne) 2022; 8:797018. [PMID: 35071277 PMCID: PMC8766506 DOI: 10.3389/fmed.2021.797018] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022] Open
Abstract
In recent years, ultrasonographic measurement of the optic nerve sheath diameter (ONSD) has been widely used to identify the presence of increased intracranial pressure (ICP). Intracranial hypertension is a life-threatening condition that can be caused by various neurological and non-neurological disorders, and it is associated to poor clinical results. Ultrasonography could be used to qualitatively and efficiently detect ICP increases, but to reach this purpose, clear cut-off values are mandatory. The aim of this review is to provide a wide overview of the most important scientific publications on optic nerve ultrasound normal values assessment published in the last 30 years. A total of 42 articles selected from PubMed medical database was included in this review. Our analysis showed that ocular ultrasonography is considered to be a valuable diagnostic tool, especially when intracranial hypertension is suspected, but unfortunately this research provided conflicting results that could be due to the different ultrasound protocols. This is mainly caused by the use of B scan alone, which presents several limitations. The use of B-scan coupled with the standardized A-scan approach could give more accurate, and reliable ultrasound evaluation, assuring higher data objectivity.
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Affiliation(s)
- Livio Vitiello
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Maddalena De Bernardo
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Luigi Capasso
- Corneal Transplant Unit, Azienda Sanitaria Locale (ASL) Napoli 1, Naples, Italy
| | - Palmiro Cornetta
- Eye Unit, "Maria SS Addolorata" Hospital, Azienda Sanitaria Locale (ASL) Salerno, Eboli, Italy
| | - Nicola Rosa
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
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Wang J, Yang M, Xu H, Huang C, Xia Z, Cheng Y, Shu X, Li Y, Shi B, Qin C, Xiao S, Liu M, Tang W. Diagnostic value of ONSD in sepsis associated encephalopathy of New Zealand rabbits. Brain Res Bull 2021; 179:68-73. [PMID: 34871709 DOI: 10.1016/j.brainresbull.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/07/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of the present study was to assess whether optic nerve sheath diameter (ONSD) measured by ultrasound could predict brain injury in sepsis associated encephalopathy (SAE). METHODS A total of 48 male New Zealand White rabbits were used to establish sepsis model. The levels of neuro-specific enolase (NSE), S100B, myeloperoxidase (MPO), and tumor necrosis factor-α (TNF-α) were detected by enzyme-linked immuno sorbent assay and ONSD were measured before modeling, 6 h, 12 h and 24 h after modeling. Sixteen rabbits were sacrificed for hematoxylin-eosin (HE) staining of brain tissue and the brain water content at above time points. Rabbits demonstrated brain injury by HE staining were included in the SAE group, the others were enrolled in the control group. The correlation between ONSD and MPO, NSE and S100B in the SAE group were analyzed. Receiver operator characteristic curves were generated to analyze the area under the curve (AUC), specificity and sensitivity of ONSD values for SAE. RESULTS Twenty-nine of 48 rabbits had brain injury, while 19 cases were enrolled in the control group. The level of MPO, NSE, S100B, TNF-α at 6 h, 12 h and 24 h in SAE group were all higher than those of the control group with statistical significance. The ONSD in SAE group increased with time and significantly wider than those in the control group. Correlation analysis revealed that ONSD was positively correlated with MPO, NSE and S100B in the SAE group. The AUCs for the ONSD value in diagnosing SAE at 6 h, 12 h and 24 h were 0.864, 0.957, 0.877, respectively. CONCLUSIONS Alterations in ONSD strongly correlated with MPO, NSE and S100B among SAE rabbits. Monitoring of ONSD exhibited a high predictive value for SAE.
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Affiliation(s)
- Jun Wang
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Yang
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hui Xu
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengjiao Huang
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi Xia
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Cheng
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolan Shu
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Li
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Buyun Shi
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenguang Qin
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuna Xiao
- LiYuan Cardiovascular Center, Liyuan Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mei Liu
- Hospital Infection Management Department, Wuhan No.1 Hospital, Wuhan, China
| | - Wen Tang
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Optic Nerve Ultrasound Evaluation in Acute High Altitude Illness. Wilderness Environ Med 2021; 32:407-408. [PMID: 34301480 DOI: 10.1016/j.wem.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022]
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Cenik Y, Baydin A, Çakmak E, Fidan M, Aydin K, Tuncel ÖK, Aslan K. The Effect of Biomarkers and Optic Nerve Sheath Diameter in Determining Mortality in non-Traumatic Subarachnoid Hemorrhage. Clin Neurol Neurosurg 2021; 207:106813. [PMID: 34311386 DOI: 10.1016/j.clineuro.2021.106813] [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: 04/13/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
AIM Although radiological methods are sufficient for the diagnosis of spontaneous subarachnoid hemorrhage (SAH), additional biomarkers are needed to predict prognosis. The aim of this study was to investigate the effects of serum S100B protein, Glial Fibrillary Acidic Protein (GFAP) levels and, Optic Nerve Sheath Diameter (ONSD) on mortality and clinical severity in patients with spontaneous SAH. MATERIALS AND METHODS Fifty-six patients who were diagnosed with SAH after first evaluation in the emergency department (ED) were included in the study group; Forty-six patients who were admitted to the ED with headache of non-intracranial etiology, were included as the control group. Cerebral computed tomography (CT) images and peripheral blood samples were obtained from all patients; at the time of diagnosis and 24 h after diagnosis. Serum S100B protein and GFAP levels were measured from the blood samples and ONSD was measured on CT. RESULTS Serum S100B protein and GFAP levels and, ONSDs at the time of diagnosis and 24 h after diagnosis were significantly higher in the study group (p < 0.05). Both GFAP levels and ONSD at the time of diagnosis and 24 h after the diagnosis were found to be related with increased mortality (p < 0.05). A similar association was found for serum S100B protein levels 24 h after the diagnosis, but not at the time of diagnosis (p = 0.540). CONCLUSION Serum S100B protein and GFAP levels and, ONSD were increased in patients with spontaneous SAH. All parameters were found to be associated with increased mortality.
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Affiliation(s)
- Yavuz Cenik
- Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Ahmet Baydin
- Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey.
| | - Eser Çakmak
- Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Murat Fidan
- Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Keramettin Aydin
- Department of Neurosurgery, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Özgür Korhan Tuncel
- Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Kerim Aslan
- Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
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Vitiello L, Capasso L, De Bernardo M, Rosa N. Pediatric ultrasound evaluation of optic disc elevation to detect intracranial hypertension. Am J Emerg Med 2021; 53:279-280. [PMID: 34158214 DOI: 10.1016/j.ajem.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/05/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Livio Vitiello
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Luigi Capasso
- Corneal Transplant Unit, ASL Napoli 1, Naples, Italy
| | - Maddalena De Bernardo
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.
| | - Nicola Rosa
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
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12
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Vitiello L, Capasso L, Bernardo MD, Rosa N. Optic Nerve Ultrasound Evaluation in Intracranial Hypertension Detection. Clin Neurol Neurosurg 2021; 207:106758. [PMID: 34210563 DOI: 10.1016/j.clineuro.2021.106758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Livio Vitiello
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Luigi Capasso
- Corneal Transplant Unit, ASL Napoli 1, Naples, Italy
| | - Maddalena De Bernardo
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy.
| | - Nicola Rosa
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
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Chen HX, Wang LJ, Xing YQ. Reply to: Ocular ultrasonography to detect intracranial pressure in aneurysmal subarachnoid hemorrhage. Ann Clin Transl Neurol 2020; 7:1461. [PMID: 32662163 PMCID: PMC7448196 DOI: 10.1002/acn3.51117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hong-Xiu Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Li-Juan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Ying-Qi Xing
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
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