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Pusateri AE, Morgan CG, Neidert LE, Tiller MM, Glaser JJ, Weiskopf RB, Ebrahim I, Stassen W, Rambharose S, Mahoney SH, Wallis LA, Hollis EM, Delong GT, Cardin S. Safety of Bioplasma FDP and Hemopure in rhesus macaques after 30% hemorrhage. Trauma Surg Acute Care Open 2024; 9:e001147. [PMID: 38196929 PMCID: PMC10773430 DOI: 10.1136/tsaco-2023-001147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/03/2023] [Indexed: 01/11/2024] Open
Abstract
Objectives Prehospital transfusion can be life-saving when transport is delayed but conventional plasma, red cells, and whole blood are often unavailable out of hospital. Shelf-stable products are needed as a temporary bridge to in-hospital transfusion. Bioplasma FDP (freeze-dried plasma) and Hemopure (hemoglobin-based oxygen carrier; HBOC) are products with potential for prehospital use. In vivo use of these products together has not been reported. This study assessed the safety of intravenous administration of HBOC+FDP, relative to normal saline (NS), in rhesus macaques (RM). Methods After 30% blood volume removal and 30 minutes in shock, animals were resuscitated with either NS or two units (RM size adjusted) each of HBOC+FDP during 60 minutes. Sequential blood samples were collected. After neurological assessment, animals were killed at 24 hours and tissues collected for histopathology. Results Due to a shortage of RM during the COVID-19 pandemic, the study was stopped after nine animals (HBOC+FDP, seven; NS, two). All animals displayed physiologic and tissue changes consistent with hemorrhagic shock and recovered normally. There was no pattern of cardiovascular, blood gas, metabolic, coagulation, histologic, or neurological changes suggestive of risk associated with HBOC+FDP. Conclusion There was no evidence of harm associated with the combined use of Hemopure and Bioplasma FDP. No differences were noted between groups in safety-related cardiovascular, pulmonary, renal or other organ or metabolic parameters. Hemostasis and thrombosis-related parameters were consistent with expected responses to hemorrhagic shock and did not differ between groups. All animals survived normally with intact neurological function. Level of evidence Not applicable.
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Affiliation(s)
| | - Clifford G Morgan
- Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, Fort Sam Houston, Texas, USA
| | - Leslie E Neidert
- Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, Fort Sam Houston, Texas, USA
| | - Michael M Tiller
- Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, Fort Sam Houston, Texas, USA
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Jacob J Glaser
- Providence Regional Medical Center, Everett, Washington, USA
| | - Richard B Weiskopf
- Department of Anesthesia and Perioperative Medcine, University of California San Francisco, San Francisco, California, USA
| | - Ismaeel Ebrahim
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Willem Stassen
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Sanjeev Rambharose
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Scott H Mahoney
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Lee A Wallis
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Ewell M Hollis
- Naval Medical Research Unit San Antonio, Fort Sam Houston, Texas, USA
| | - Gerald T Delong
- Naval Medical Research Unit San Antonio, Fort Sam Houston, Texas, USA
| | - Sylvain Cardin
- Naval Medical Research Unit San Antonio, Fort Sam Houston, Texas, USA
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2
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Ouin E, Jouvent E. [Clinico-radiological spectrum of cerebral small vessel diseases]. Rev Med Interne 2020; 41:459-468. [PMID: 32540119 DOI: 10.1016/j.revmed.2020.02.013] [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: 12/04/2019] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 11/18/2022]
Abstract
Cerebral small vessel diseases are frequent and can be seen through all ages. Although the most frequent forms related to age and hypertension or to cerebral amyloid angiopathy are mainly observed in subjects over 50 years of age, rarer forms may affect young people, sometimes even children. Some familial or inflammatory forms can be particularly misleading with some presentations very difficult to relate to a microvascular origin. Cerebral small vessel diseases thus raise both daily therapeutic issues and much rarer diagnostic questions, sometimes extremely complex. Our aim was to review the main clinical initial presentations and the clinico-radiological spectrum of associated underlying conditions.
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Affiliation(s)
- E Ouin
- Inserm U1141, service de neurologie et centre des maladies vasculaires rares du cerveau et de l'œil (CERVCO), hôpital Lariboisière, université de Paris, AP-HP, 75475 Paris, France; Département de neurologie, hôpitaux universitaires d'Amiens, Amiens, France
| | - E Jouvent
- Inserm U1141, service de neurologie et centre des maladies vasculaires rares du cerveau et de l'œil (CERVCO), hôpital Lariboisière, université de Paris, AP-HP, 75475 Paris, France.
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Dewey CW, Rishniw M, Johnson PJ, Davies ES, Sackman JJ, O'Donnell M, Platt S, Robinson K. Interthalamic adhesion size in aging dogs with presumptive spontaneous brain microhemorrhages: a comparative retrospective MRI study of dogs with and without evidence of canine cognitive dysfunction. PeerJ 2020; 8:e9012. [PMID: 32322448 PMCID: PMC7161569 DOI: 10.7717/peerj.9012] [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: 07/16/2019] [Accepted: 03/27/2020] [Indexed: 12/04/2022] Open
Abstract
Objective Spontaneous brain microhemorrhages in elderly people are present to some degree in Alzheimer’s disease patients but have been linked to brain atrophy in the absence of obvious cognitive decline. Brain microhemorrhages have recently been described in older dogs, but it is unclear whether these are associated with brain atrophy. Diminution of interthalamic adhesion size-as measured on MRI or CT-has been shown to be a reliable indicator of brain atrophy in dogs with canine cognitive dysfunction (CCD) in comparison with successfully aging dogs. We hypothesized that aging dogs with brain microhemorrhages presenting for neurologic dysfunction but without obvious features of cognitive decline would have small interthalamic adhesion measurements, like dogs with CCD, compared with control dogs. The objective of this study was to compare interthalamic adhesion size between three groups of aging (>9 years) dogs: (1) neurologically impaired dogs with presumptive spontaneous brain microhemorrhages and no clinical evidence of cognitive dysfunction (2) dogs with CCD (3) dogs without clinical evidence of encephalopathy on neurologic examination (control dogs). MR images from 52 aging dogs were reviewed and measurements were obtained of interthalamic adhesion height (thickness) and mid-sagittal interthalamic adhesion area for all dogs, in addition to total brain volume. Interthalamic adhesion measurements, either absolute or normalized to total brain volume were compared between groups. Signalment (age, breed, sex), body weight, presence and number of SBMs, as well as other abnormal MRI findings were recorded for all dogs. Results All interthalamic adhesion measurement parameters were significantly (P < 0.05) different between control dogs and affected dogs. Both dogs with cognitive dysfunction (12/15; 80%) and dogs with isolated brain microhemorrhages had more microhemorrhages than control dogs (3/25; 12%). Affected dogs without cognitive dysfunction had significantly more microhemorrhages than dogs with cognitive dysfunction. In addition to signs of cognitive impairment for the CCD group, main clinical complaints for SBM and CCD dogs were referable to central vestibular dysfunction, recent-onset seizure activity, or both. Geriatric dogs with spontaneous brain microhemorrhages without cognitive dysfunction have similar MRI abnormalities as dogs with cognitive dysfunction but may represent a distinct disease category.
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Affiliation(s)
- Curtis W Dewey
- Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA.,Long Island Veterinary Specialists, Plainview, NY, USA.,Rochester Veterinary Specialists and Emergency Services, Rochester, NY, USA
| | - Mark Rishniw
- Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Philippa J Johnson
- Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Emma S Davies
- Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | | | | | - Simon Platt
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, USA
| | - Kelsey Robinson
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, USA
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Puy L, Cordonnier C. Microsanguinamenti intracerebrali. Neurologia 2019. [DOI: 10.1016/s1634-7072(19)42493-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Soman S, Liu Z, Kim G, Nemec U, Holdsworth SJ, Main K, Lee B, Kolakowsky-Hayner S, Selim M, Furst AJ, Massaband P, Yesavage J, Adamson MM, Spincemaille P, Moseley M, Wang Y. Brain Injury Lesion Imaging Using Preconditioned Quantitative Susceptibility Mapping without Skull Stripping. AJNR Am J Neuroradiol 2018; 39:648-653. [PMID: 29472296 DOI: 10.3174/ajnr.a5550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/04/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Identifying cerebral microhemorrhage burden can aid in the diagnosis and management of traumatic brain injury, stroke, hypertension, and cerebral amyloid angiopathy. MR imaging susceptibility-based methods are more sensitive than CT for detecting cerebral microhemorrhage, but methods other than quantitative susceptibility mapping provide results that vary with field strength and TE, require additional phase maps to distinguish blood from calcification, and depict cerebral microhemorrhages as bloom artifacts. Quantitative susceptibility mapping provides universal quantification of tissue magnetic property without these constraints but traditionally requires a mask generated by skull-stripping, which can pose challenges at tissue interphases. We evaluated the preconditioned quantitative susceptibility mapping MR imaging method, which does not require skull-stripping, for improved depiction of brain parenchyma and pathology. MATERIALS AND METHODS Fifty-six subjects underwent brain MR imaging with a 3D multiecho gradient recalled echo acquisition. Mask-based quantitative susceptibility mapping images were created using a commonly used mask-based quantitative susceptibility mapping method, and preconditioned quantitative susceptibility images were made using precondition-based total field inversion. All images were reviewed by a neuroradiologist and a radiology resident. RESULTS Ten subjects (18%), all with traumatic brain injury, demonstrated blood products on 3D gradient recalled echo imaging. All lesions were visible on preconditioned quantitative susceptibility mapping, while 6 were not visible on mask-based quantitative susceptibility mapping. Thirty-one subjects (55%) demonstrated brain parenchyma and/or lesions that were visible on preconditioned quantitative susceptibility mapping but not on mask-based quantitative susceptibility mapping. Six subjects (11%) demonstrated pons artifacts on preconditioned quantitative susceptibility mapping and mask-based quantitative susceptibility mapping; they were worse on preconditioned quantitative susceptibility mapping. CONCLUSIONS Preconditioned quantitative susceptibility mapping MR imaging can bring the benefits of quantitative susceptibility mapping imaging to clinical practice without the limitations of mask-based quantitative susceptibility mapping, especially for evaluating cerebral microhemorrhage-associated pathologies, such as traumatic brain injury.
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Affiliation(s)
- S Soman
- From the Departments of Radiology (S.S., G.K., B.L.)
| | - Z Liu
- Department of Biomedical Engineering (Z.L., Y.W.), Cornell University, New York, New York
| | - G Kim
- From the Departments of Radiology (S.S., G.K., B.L.)
| | - U Nemec
- Department of Biomedical Imaging and Image-Guided Therapy (U.N.), Medical University of Vienna, Vienna, Austria
| | | | - K Main
- Research Division, Defense and Veterans Brain Injury Center (K.M.), General Dynamics Health Solutions, Silver Spring, Maryland
| | - B Lee
- From the Departments of Radiology (S.S., G.K., B.L.)
| | - S Kolakowsky-Hayner
- Department of Rehabilitation Medicine (S.K.-H.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - M Selim
- Neurology (M.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - A J Furst
- Psychiatry and Behavioral Sciences (A.J.F., J.Y., M.M.A.)
- Departments of Psychiatry (A.J.F., J.Y.)
| | - P Massaband
- Departments of Radiology (S.J.H., P.M., M.M.)
- Radiology (P.M.)
| | - J Yesavage
- Psychiatry and Behavioral Sciences (A.J.F., J.Y., M.M.A.)
- Departments of Psychiatry (A.J.F., J.Y.)
| | - M M Adamson
- Psychiatry and Behavioral Sciences (A.J.F., J.Y., M.M.A.)
- Neurosurgery (M.M.A.), Stanford University, Stanford, California
- Defense and Veterans Brain Injury Center (M.M.A.), VA Palo Alto Health Care System, Palo Alto, California
| | - P Spincemaille
- Department of Radiology (P.S., Y.W.), Weil Cornell Medical College, New York, New York
| | - M Moseley
- Departments of Radiology (S.J.H., P.M., M.M.)
| | - Y Wang
- Department of Biomedical Engineering (Z.L., Y.W.), Cornell University, New York, New York
- Department of Radiology (P.S., Y.W.), Weil Cornell Medical College, New York, New York
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Daugherty AM, Raz N. Incident risk and progression of cerebral microbleeds in healthy adults: a multi-occasion longitudinal study. Neurobiol Aging 2017; 59:22-29. [PMID: 28800410 PMCID: PMC5612885 DOI: 10.1016/j.neurobiolaging.2017.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/24/2017] [Accepted: 07/10/2017] [Indexed: 12/21/2022]
Abstract
Decline in cerebrovascular health complicates brain aging, and development of cerebral microbleeds (CMBs) is one of its prominent indicators. In a large sample of healthy adults (N = 251, age 18-78 years at baseline, 70% women), the contributions of chronological age and vascular health indicators to the risk of developing a CMB, as well as the change in CMB size and iron content, were examined in a prospective 8-year longitudinal study using susceptibility weighted imaging. Twenty-six persons (10.4%), most of whom were 40 years of age or older, had at least 1 CMB during the study. Older age was associated with greater risk for developing a CMB (odds ratio 1.03). Elevation of combined metabolic syndrome indicators (b = 0.15, p = 0.001) conferred additional risk (odds ratio 1.02). High body mass index exacerbated the risk associated with poor vascular health (b = 0.75, p < 0.001) and frequent exercise mitigated it (b = -0.46, p = 0.03). CMBs persisted over time, yet their volume decreased (mean change = -0.32, p < 0.05), whereas their relative iron content remained stable (mean change = -0.14, p = 0.05). We conclude that although developing a CMB is unlikely during normal aging, risk increases with declining vascular health, which is modifiable via behavioral and pharmaceutical intervention.
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Affiliation(s)
- Ana M Daugherty
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA.
| | - Naftali Raz
- Department of Psychology and Institute of Gerontology, Wayne State University, Detroit, MI, USA; Max Planck Institute for Human Development, Berlin, Germany
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Puy L, De Guio F, Godin O, Duering M, Dichgans M, Chabriat H, Jouvent E. Cerebral Microbleeds and the Risk of Incident Ischemic Stroke in CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy). Stroke 2017; 48:2699-2703. [PMID: 28842512 DOI: 10.1161/strokeaha.117.017839] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral microbleeds are associated with an increased risk of intracerebral hemorrhage. Recent data suggest that microbleeds may also predict the risk of incident ischemic stroke. However, these results were observed in elderly individuals undertaking various medications and for whom causes of microbleeds and ischemic stroke may differ. We aimed to test the relationship between the presence of microbleeds and incident stroke in CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy)-a severe monogenic small vessel disease known to be responsible for both highly prevalent microbleeds and a high incidence of ischemic stroke in young patients. METHODS We assessed microbleeds on baseline MRI in all 378 patients from the Paris-Munich cohort study. Incident ischemic strokes were recorded during 54 months. Survival analyses were used to test the relationship between microbleeds and incident ischemic stroke. RESULTS Three hundred sixty-nine patients (mean age, 51.4±11.4 years) were followed-up during a median time of 39 months (interquartile range, 19 months). The risk of incident ischemic stroke was higher in patients with microbleeds than in patients without (35.8% versus 19.6%, hazard ratio, 1.87; 95% confidence interval, 1.16-3.01; P=0.009). These results persisted after adjustment for history of ischemic stroke, age, sex, vascular risk factors, and antiplatelet agents use (hazard ratio, 1.89; 95% confidence interval, 1.10-3.26; P=0.02). CONCLUSIONS The presence of microbleeds is an independent risk marker of incident ischemic stroke in CADASIL, emphasizing the need to carefully interpret MRI data.
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Affiliation(s)
- Laurent Puy
- From the University Paris Diderot, Sorbonne Paris Cité, INSERM, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology, APHP Lariboisière Hospital, Paris, France (L.P., F.D.G., O.G., H.C., E.J.); DHU NeuroVasc Sorbonne Paris Cité, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology (L.P.) and Laboratory of Functional Neurosciences (L.P.), University Hospital of Amiens, France (L.P.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig Maximilian University, Munich, Germany (M. Duering, M. Dichgans); and Munich Cluster of Systems Neurology, Germany (M. Dichgans)
| | - François De Guio
- From the University Paris Diderot, Sorbonne Paris Cité, INSERM, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology, APHP Lariboisière Hospital, Paris, France (L.P., F.D.G., O.G., H.C., E.J.); DHU NeuroVasc Sorbonne Paris Cité, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology (L.P.) and Laboratory of Functional Neurosciences (L.P.), University Hospital of Amiens, France (L.P.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig Maximilian University, Munich, Germany (M. Duering, M. Dichgans); and Munich Cluster of Systems Neurology, Germany (M. Dichgans)
| | - Ophélia Godin
- From the University Paris Diderot, Sorbonne Paris Cité, INSERM, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology, APHP Lariboisière Hospital, Paris, France (L.P., F.D.G., O.G., H.C., E.J.); DHU NeuroVasc Sorbonne Paris Cité, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology (L.P.) and Laboratory of Functional Neurosciences (L.P.), University Hospital of Amiens, France (L.P.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig Maximilian University, Munich, Germany (M. Duering, M. Dichgans); and Munich Cluster of Systems Neurology, Germany (M. Dichgans)
| | - Marco Duering
- From the University Paris Diderot, Sorbonne Paris Cité, INSERM, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology, APHP Lariboisière Hospital, Paris, France (L.P., F.D.G., O.G., H.C., E.J.); DHU NeuroVasc Sorbonne Paris Cité, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology (L.P.) and Laboratory of Functional Neurosciences (L.P.), University Hospital of Amiens, France (L.P.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig Maximilian University, Munich, Germany (M. Duering, M. Dichgans); and Munich Cluster of Systems Neurology, Germany (M. Dichgans)
| | - Martin Dichgans
- From the University Paris Diderot, Sorbonne Paris Cité, INSERM, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology, APHP Lariboisière Hospital, Paris, France (L.P., F.D.G., O.G., H.C., E.J.); DHU NeuroVasc Sorbonne Paris Cité, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology (L.P.) and Laboratory of Functional Neurosciences (L.P.), University Hospital of Amiens, France (L.P.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig Maximilian University, Munich, Germany (M. Duering, M. Dichgans); and Munich Cluster of Systems Neurology, Germany (M. Dichgans)
| | - Hugues Chabriat
- From the University Paris Diderot, Sorbonne Paris Cité, INSERM, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology, APHP Lariboisière Hospital, Paris, France (L.P., F.D.G., O.G., H.C., E.J.); DHU NeuroVasc Sorbonne Paris Cité, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology (L.P.) and Laboratory of Functional Neurosciences (L.P.), University Hospital of Amiens, France (L.P.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig Maximilian University, Munich, Germany (M. Duering, M. Dichgans); and Munich Cluster of Systems Neurology, Germany (M. Dichgans)
| | - Eric Jouvent
- From the University Paris Diderot, Sorbonne Paris Cité, INSERM, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology, APHP Lariboisière Hospital, Paris, France (L.P., F.D.G., O.G., H.C., E.J.); DHU NeuroVasc Sorbonne Paris Cité, France (L.P., F.D.G., O.G., H.C., E.J.); Department of Neurology (L.P.) and Laboratory of Functional Neurosciences (L.P.), University Hospital of Amiens, France (L.P.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig Maximilian University, Munich, Germany (M. Duering, M. Dichgans); and Munich Cluster of Systems Neurology, Germany (M. Dichgans).
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