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Cheronis C, Silverman A, George PM. Eye Toward Stroke Prevention: Central Retinal Artery Occlusion and Tandem Internal Carotid Artery Occlusion. Stroke 2024; 55:e165-e168. [PMID: 38511307 DOI: 10.1161/strokeaha.123.045957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Chrisoula Cheronis
- Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA
| | - Andrew Silverman
- Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA
| | - Paul M George
- Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA
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Lange KS, Mourand I, Coget A, Menjot de Champfleur N, Ayrignac X, Arquizan C, Scheel M, Bohner G, Villringer K, Zagroun C, Siebert E, Danyel LA. Diffusion-weighted magnetic resonance imaging in early central retinal artery occlusion. Eur Stroke J 2023; 8:974-981. [PMID: 37997381 PMCID: PMC10683725 DOI: 10.1177/23969873231190716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Restricted retinal diffusion (RDR) has recently been recognized as a frequent finding on standard diffusion-weighted imaging (DWI) in central retinal artery occlusion (CRAO). However, data on early DWI signal evolution are missing. PATIENTS AND METHODS Consecutive CRAO patients with DWI performed within 24 h after onset of visual impairment were included in a bicentric, retrospective cross-sectional study. Two blinded neuroradiologists assessed randomized DWI scans for the presence of retinal ischemia. RDR detection rates, false positive ratings, and interrater agreement were evaluated for predefined time groups. RESULTS Sixty eight CRAO patients (68.4 ± 16.8 years; 25 female) with 72 DWI scans (76.4% 3 T, 23.6% 1.5 T) were included. Mean time-delay between onset of CRAO and DWI acquisition was 13.4 ± 7.0 h. Overall RDR detection rates ranged from 52.8% to 62.5% with false positive ratings in 4.2%-8.3% of cases. RDR detection rates were higher in DWI performed 12-24 h after onset, when compared with DWI acquired within the first 12 h (79.5%vs 39.3%, p < 0.001). The share of false positive ratings was highest for DWI performed within the first 6 h of symptom onset (up to 14.3%). Interrater reliability was "moderate" for DWI performed within the first 18 h (κ = 0.57-0.58), but improved for DWI acquired between 18 and 24 h (κ = 0.94). CONCLUSION DWI-based detection of retinal ischemia in early CRAO is likely to be time-dependent with superior diagnostic accuracy for DWI performed 12-24 h after onset of visual impairment.
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Affiliation(s)
- Kristin Sophie Lange
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Isabelle Mourand
- Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Arthur Coget
- Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Nicolas Menjot de Champfleur
- Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
- I2FH, Institut d’Imagerie Fonctionnelle Humaine, Hôpital Gui de Chauliac, CHRU de Montpellier, Montpellier, France
| | - Xavier Ayrignac
- Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Michael Scheel
- Institute for Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Bohner
- Institute for Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kersten Villringer
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Charlie Zagroun
- Department of Ophthalmology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Eberhard Siebert
- Institute for Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Parikh PP, Harahsheh EY, Dumitrascu OM. Unilateral Optic Nerve Diffusion Restriction After Sinus Surgery Secondary to Central Retinal Artery Occlusion: Case Report and Literature Review. Neurologist 2023; 28:46-48. [PMID: 35348478 DOI: 10.1097/nrl.0000000000000433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Permanent perioperative vision loss is caused by ischemic optic neuropathy (ION) or central retinal artery occlusion (CRAO). Whereas diffusion restriction of the optic nerve (ON) on brain magnetic resonance imaging has been previously reported in perioperative posterior ION (PION), there are no reports of ON diffusion restriction in patients diagnosed with acute perioperative CRAO. We present a case of perioperative CRAO to highlight this neuroimaging finding for neuroradiologists and neurologists. CASE REPORT A 71-year-old male without vascular risk factors underwent maxillary bilateral antrostomy and septoplasty for chronic sinusitis. Twenty to thirty minutes upon awakening, he complained of painless left eye vision loss. Ophthalmoscopic examination showed retinal whitening, segmented arterioles, and hyperemic disc. Brain MR-diffusion weighted imaging/apparent diffusion coefficient revealed ON diffusion restriction in the proximal segment. Despite attempted reperfusion, left eye remained with no light perception at 6 months. Patients undergoing nonocular surgeries who develop perioperative vision loss related to PION may exhibit ON diffusion restriction but usually have normal ophthalmoscopic findings. CRAO shows retinal whitening, edema, segmentation of arterioles, and cherry red spot on ophthalmoscopy. A recent study reported that ON diffusion restriction in nonperioperative CRAO cases has a sensitivity and specificity of 55% and 70% to 100%. Here, PION was initially considered based on imaging. However, given the neuro-ophthalmic findings, a proximal embolus in the central retinal artery, obstructing its entrance into the proximal ON was deemed more likely. CONCLUSION We highlight that proximal ON diffusion restriction on brain magnetic resonance imaging can be diagnostic of proximal thromboembolic CRAO. Future studies should evaluate the diagnostic utility and accuracy of MR-diffusion weighted imaging/apparent diffusion coefficient in perioperative visual loss.
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Utility of standard diffusion-weighted magnetic resonance imaging for the identification of ischemic optic neuropathy in giant cell arteritis. Sci Rep 2022; 12:16553. [PMID: 36192437 PMCID: PMC9530116 DOI: 10.1038/s41598-022-20916-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
This study assessed diffusion abnormalities of the optic nerve (ON) in giant cell arteritis (GCA) patients with acute onset of visual impairment (VI) using diffusion-weighted magnetic resonance imaging (DWI). DWI scans of GCA patients with acute VI were evaluated in a case-control study. Two blinded neuroradiologists assessed randomized DWI scans of GCA and controls for ON restricted diffusion. Statistical quality criteria and inter-rater reliability (IRR) were calculated. DWI findings were compared to ophthalmological assessments. 35 GCA patients (76.2 ± 6.4 years; 37 scans) and 35 controls (75.7 ± 7.6 years; 38 scans) were included. ON restricted diffusion was detected in 81.1% (Reader 1) of GCA scans. Localization of ON restricted diffusion was at the optic nerve head in 80.6%, intraorbital in 11.1% and affecting both segments in 8.3%. DWI discerned affected from unaffected ON with a sensitivity, specificity, positive and negative predictive value of 87%/99%/96%/96%. IRR for ON restricted diffusion was κinter = 0.72 (95% CI 0.59–0.86). DWI findings challenged ophthalmologic diagnoses in 4 cases (11.4%). DWI visualizes anterior and posterior ON ischemia in GCA patients with high sensitivity and specificity, as well as substantial IRR. DWI may complement the ophthalmological assessment in patients with acute VI.
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Boyko M, Dumitrascu O, Saindane AM, Hoxworth JM, Hu R, Rath T, Chan W, Flowers AM, Harahsheh E, Parikh P, Elshaigi O, Meyer BI, Newman NJ, Biousse V. Retinal and optic nerve magnetic resonance diffusion-weighted imaging in acute non-arteritic central retinal artery occlusion. J Stroke Cerebrovasc Dis 2022; 31:106644. [PMID: 35849917 PMCID: PMC9579870 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/25/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES Diffusion weighted imaging hyperintensity (DWI-H) has been described in the retina and optic nerve during acute central retinal artery occlusion (CRAO). We aimed to determine whether DWI-H can be accurately identified on standard brain magnetic resonance imaging (MRI) in non-arteritic CRAO patients at two tertiary academic centers. MATERIALS AND METHODS Retrospective cross-sectional study that included all consecutive adult patients with confirmed acute non-arteritic CRAO and brain MRI performed within 14 days of CRAO. At each center, two neuroradiologists masked to patient clinical data reviewed each MRI for DWI-H in the retina and optic nerve, first independently then together. Statistical analysis for inter-rater reliability and correlation with clinical data was performed. RESULTS We included 204 patients [mean age 67.9±14.6 years; 47.5% females; median time from CRAO to MRI 1 day (IQR 1-4.3); 1.5 T in 127/204 (62.3%) and 3.0 T in 77/204 (37.7%)]. Inter-rater reliability varied between centers (κ = 0.27 vs. κ = 0.65) and was better for retinal DWI-H. Miss and error rates significantly differed between neuroradiologists at each center. After consensus review, DWI-H was identified in 87/204 (42.6%) patients [miss rate 117/204 (57.4%) and error rate 11/87 (12.6%)]. Significantly more patients without DWI-H had good visual acuity at follow-up (p = 0.038). CONCLUSIONS In this real-world case series, differences in agreement and interpretation accuracy among neuroradiologists limited the role of DWI-H in diagnosing acute CRAO on standard MRI. DWI-H was identified in 42.6% of patients and was more accurately detected in the retina than in the optic nerve. Further studies are needed with standardized novel MRI protocols.
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Affiliation(s)
- Matthew Boyko
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 404-778-5158, United States
| | - Oana Dumitrascu
- Departments of Neurology and Ophthalmology, Mayo Clinic College of Medicine, Scottsdale, AZ 480-301-4151, United States
| | - Amit M Saindane
- Departments of Radiology and Imaging Sciences and Neurological Surgery, Emory University School of Medicine, Atlanta, GA 404-778-2020, United States
| | - Joseph M Hoxworth
- Department of Radiology, Division of Neuroradiology, Mayo Clinic College of Medicine Scottsdale, AZ 480-301-4151, United States
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 404-778-2020, United States
| | - Tanya Rath
- Department of Radiology, Division of Neuroradiology, Mayo Clinic College of Medicine Scottsdale, AZ 480-301-4151, United States
| | - Wesley Chan
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 404-778-5158, United States
| | - Alexis M Flowers
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 404-778-5158, United States
| | - Ehab Harahsheh
- Department of Neurology, Mayo Clinic College of Medicine Scottsdale, AZ 480-301-4151, United States
| | - Parth Parikh
- Mayo Clinic Alyx School of Medicine, Scottsdale, AZ 480-301-4151, United States
| | - Omer Elshaigi
- Mayo Clinic Alyx School of Medicine, Scottsdale, AZ 480-301-4151, United States
| | - Benjamin I Meyer
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 404-778-5158, United States
| | - Nancy J Newman
- Departments of Ophthalmology, Neurology and Neurological Surgery, Emory University School of Medicine, Atlanta, GA 404-778-5158, United States
| | - Valérie Biousse
- Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, GA 404-778-5158, United States.
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Wenzel DA, Poli S, Casagrande M, Druchkiv V, Spitzer MS, Bartz-Schmidt KU, Grohmann C, Schultheiss M. Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion. Front Med (Lausanne) 2022; 9:854288. [PMID: 35872772 PMCID: PMC9299355 DOI: 10.3389/fmed.2022.854288] [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: 01/13/2022] [Accepted: 06/20/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose To investigate inner retinal hyperreflectivity on optical coherence tomography (OCT) as a potential biomarker indicating acute central retinal artery occlusion (CRAO). Methods A total of 56 patients at two university hospitals with acute CRAO (symptom onset ≤48 h) were included in this retrospective study. The optical intensity of the inner retinal layers was determined in both eyes and the relationship between symptom onset and inner retinal layer optical intensity in OCT scans compared to the unaffected fellow eye was analyzed. Several differential diagnoses [central retinal vein occlusion, anterior ischemic optic neuropathy, diabetic macular edema, and subretinal fibrosis/disciform scar (Junius-Kuhnt)] served as controls to validate optical intensity-based diagnosis of CRAO. Results CRAO strongly correlated with an increased inner retinal layer hyperreflectivity in this cohort with acute CRAO with a time since symptom onset ranging from 1.1 to 48.0 h. Receiver operating characteristic (ROC) analysis showed an area under the curve of 0.99 to confirm CRAO with a true positive rate of 0.93 and a false positive rate of 0.02. No correlation between optical intensity and time since symptom onset was noticeable. None of the differential diagnoses did show an elevated optical intensity of the inner retinal layers as it was detectable in CRAO. Conclusion OCT-based determination of inner retinal layer hyperreflectivity is a very promising biomarker for a prompt diagnosis of CRAO in an emergency setting. This may be of major interest to speed up the administration of a possible thrombolytic treatment.
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Affiliation(s)
- Daniel A. Wenzel
- University Eye Hospital, Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Poli
- Department of Neurology and Stroke, University Hospital Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Tübingen, Germany
| | - Maria Casagrande
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin S. Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Carsten Grohmann
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schultheiss
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Maximilian Schultheiss,
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Detectability of Retinal Diffusion Restriction in Central Retinal Artery Occlusion is Linked to Inner Retinal Layer Thickness. Clin Neuroradiol 2022; 32:1037-1044. [PMID: 35503466 PMCID: PMC9744698 DOI: 10.1007/s00062-022-01168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/05/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate retinal microstructure differences in central retinal artery occlusion (CRAO) patients with and without visible retinal diffusion restriction (RDR) on diffusion-weighted magnetic resonance imaging (DWI). METHODS Consecutive CRAO patients with available optical coherence tomography (OCT) and DWI, both performed within 7 days after symptom onset, were included in a retrospective cohort study. The OCT scans were reviewed to assess retinal layer thickness, optical intensity and structural integrity. The OCT findings were compared between patients with and without visible RDR on DWI using Mann-Whitney U or Pearson's Χ2 test. RESULTS A total of 56 patients (mean age 70.8 ± 12.8 years) were included. RDR was observed in 38 subjects (67.9%) with visually correlating low ADC map in 26 of 38 cases (68.4%). Superior and inferior parafoveal macular thickness measurements (SMT, IMT) of RDR negative patients were significantly lower when compared to RDR+ patients (370.5 ± 43.8 µm vs. 418.2 ± 76.0 µm, p = 0.016; 374.4 ± 42.9 µm vs. 428.8 ± 63.2 µm, p = 0.004) due to differences in inner retinal layer thickness (IRLT, 188.8 ± 34.4 µm vs. 234.7 ± 49.0 µm, p = 0.002). IRLT values of RDR negative patients were higher in 1.5T compared to 3T the DWI (205.0 ± 26.0 µm vs. 168.6 ± 32.8 µm, p = 0.026). CONCLUSIONS Detectability of RDR is likely contingent upon the degree of ischemic retinal swelling in CRAO. Technical adjustments to the DWI protocol, such as increased field strength, may improve visibility of RDR.
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Retinal diffusion restrictions in acute branch retinal arteriolar occlusion. Sci Rep 2021; 11:20538. [PMID: 34654843 PMCID: PMC8519991 DOI: 10.1038/s41598-021-00127-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
This study sought to investigate the occurrence of retinal diffusion restrictions (RDR) in branch retinal arteriolar occlusion (BRAO) using standard brain diffusion-weighted imaging (DWI). Two radiologists assessed DWI MRI scans of BRAO patients for RDR in a retrospective cohort study. Inter- and intrarater reliability were calculated using Kappa statistics. Detection rates of RDR were compared among MRI scans with varying field strength, sequence type and onset-to-DWI time intervals. 85 BRAO patients (63.1 ± 16.5 years) and 89 DWI scans were evaluated. Overall sensitivity of RDR in BRAO was 46.1% with visually correlating low ADC signal in 56.1% of cases. Localization of RDR matched distribution of fundoscopic retinal edema in 85% of patients. Inter- and intra-rater agreement for RDR in BRAO was κinter = 0.64 (95% CI 0.48–0.80) and κintra = 0.87 (95% CI 0.76–0.96), respectively. RDR detection rate tended to be higher for 3T, when compared to 1.5T MRI scans (53.7% vs. 34.3%%; p = 0.07). RDR were identified within 24 h up to 2 weeks after onset of visual impairment. RDR in BRAO can be observed by means of standard stroke DWI in a substantial proportion of cases, although sensitivity and interrater reliability were lower than previously reported for complete central retinal artery occlusion.
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Danyel LA, Miszczuk M, Connolly F, Villringer K, Bohner G, Rossel-Zemkouo M, Siebert E. Time Course and Clinical Correlates of Retinal Diffusion Restrictions in Acute Central Retinal Artery Occlusion. AJNR Am J Neuroradiol 2021; 42:1661-1666. [PMID: 34266868 DOI: 10.3174/ajnr.a7201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Retinal diffusion restrictions were recently identified as a regular finding in acute central retinal artery occlusion. We sought to investigate the influence of technical MR imaging and clinical parameters on the detection rate of retinal diffusion restrictions on standard brain DWI. MATERIALS AND METHODS In this retrospective cohort study, MR imaging scans of patients with central retinal artery occlusion were assessed by 2 readers for retinal diffusion restrictions on DWI performed within 2 weeks after vision loss. The influence of clinical and technical MR imaging parameters and the time interval between symptom onset and DWI on the presence of retinal diffusion restrictions were evaluated. RESULTS One hundred twenty-seven patients (mean age, 69.6 [SD 13.9] years; 59 women) and 131 DWI scans were included. Overall, the MR imaging sensitivity of retinal diffusion restrictions in acute central retinal artery occlusion was 62.6%-67.2%. Interrater and intrarater agreement for retinal diffusion restrictions was "substantial" with κinter = 0.70 (95% CI, 0.57-0.83) and κintra = 0.75 (95% CI, 0.63-0.88). Detection of retinal diffusion restrictions did not differ with differences in field strengths (1.5 versus 3T, P = .35) or sequence type (P = .22). Retinal diffusion restrictions were consistently identified within the first week with a peak sensitivity of 79% in DWI performed within 24 hours after symptom onset. Sensitivity of retinal diffusion restrictions declined in the second week (10.0%, P < .001). Absence of retinal diffusion restrictions was more prevalent in patients without fundoscopic retinal edema (60% versus 27.1%, P = .004) and with restitution of visual acuity at discharge (75% versus 28.4%, P = .006). CONCLUSIONS Retinal diffusion restrictions in acute central retinal artery occlusion can be reliably identified on DWI performed within 24 hours and 1 week after onset of visual impairment. Detectability of retinal diffusion restrictions is dependent on the clinical course of the disease.
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Affiliation(s)
- L A Danyel
- From the Department of Neurology (L.A.D., F.C.)
| | - M Miszczuk
- Institute for Neuroradiology (M.M., G.B., E.S.)
| | - F Connolly
- From the Department of Neurology (L.A.D., F.C.)
| | | | - G Bohner
- Institute for Neuroradiology (M.M., G.B., E.S.)
| | - M Rossel-Zemkouo
- Department of Ophthalmology (M.R.-Z.), Charité-Universitätsmedizin, Berlin, Germany
| | - E Siebert
- Institute for Neuroradiology (M.M., G.B., E.S.)
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