1
|
Koch MS, Drewnowski B, Rickli C, dos Santos FA, Baroni G, Vellosa JCR. The influence of hemodialysis on intracranial pressure waveform in patients with chronic kidney disease: an observational study. SAO PAULO MED J 2023; 142:e2023068. [PMID: 38018633 PMCID: PMC10681329 DOI: 10.1590/1516-3180.2023.0068.r1.07072023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/11/2023] [Accepted: 07/07/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Among the complications related to chronic kidney disease (CKD), those of a neurological nature stand out, and for a better quality of life for patients, the diagnosis and treatment of these complications is fundamental. OBJECTIVES This study aimed to assess the effect of hemodialysis on intracranial pressure waveform (ICPw) in patients with chronic kidney disease undergoing hemodialysis and those who are not yet undergoing substitutive therapy. DESIGN AND SETTING An observational study was conducted in two stages at a kidney replacement therapy center in Brazil. The first was a longitudinal study and the second was a cross-sectional study. METHODS Forty-two patients on hemodialysis were included in the first stage of the study. In the second stage, 226 participants were included. Of these, 186 were individuals with chronic kidney disease (who were not undergoing substitutive therapy), and 40 did not have the disease (control group). The participants' intracranial compliance was assessed using the non-invasive Brain4care method, and the results were compared between the groups. RESULTS There was a significant difference between the hemodialysis and non-hemodialysis groups, with the former having better ICPw conditions. CONCLUSIONS Hemodialysis influenced the improvement in ICPw, probably due to the decrease in the patients' extra-and intracellular volumes. Furthermore, ICPw monitoring can be a new parameter to consider when defining the moment to start substitutive therapy.
Collapse
Affiliation(s)
- Mariana Schechtel Koch
- PhD Candidate, Biologist. Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa (PR), Brazil
| | - Bianca Drewnowski
- PhD Candidate. Pharmacist. Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa (PR), Brazil
| | - Cristiane Rickli
- PhD. Biomedic, Professor, Centro Universitário Integrado, Campo Mourão (PR), Brazil
| | - Fábio André dos Santos
- PhD. Dentist, Associate Professor, Biological and Health Sciences Division, Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa (PR), Brazil
| | - Gilberto Baroni
- PhD. Physician, Adjunct Professor, Biological and Health Sciences Division, Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa (PR), Brazil
| | - José Carlos Rebuglio Vellosa
- PhD. Pharmacist, Associate Professor, Biological and Health Sciences Division, Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa (PR), Brazil
| |
Collapse
|
2
|
Eide PK. Cellular changes at the glia-neuro-vascular interface in definite idiopathic normal pressure hydrocephalus. Front Cell Neurosci 2022; 16:981399. [PMID: 36119130 PMCID: PMC9478415 DOI: 10.3389/fncel.2022.981399] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a subtype of dementia with overlap toward Alzheimer's disease. Both diseases show deposition of the toxic metabolites amyloid-β and tau in brain. A unique feature with iNPH is that a subset of patients may improve clinically following cerebrospinal fluid (CSF) diversion (shunt) surgery. The patients responding clinically to shunting are denoted Definite iNPH, otherwise iNPH is diagnosed as Possible iNPH or Probable iNPH, high-lightening that the clinical phenotype and underlying pathophysiology remain debated. Given the role of CSF disturbance in iNPH, the water channel aquaporin-4 (AQP4) has been suggested a crucial role in iNPH. Altered expression of AQP4 at the astrocytic endfeet facing the capillaries could affect glymphatic function, i.e., the perivascular transport of fluids and solutes, including soluble amyloid-β and tau. This present study asked how altered perivascular expression of AQP4 in subjects with definite iNPH is accompanied with cellular changes at the glia-neuro-vascular interface. For this purpose, information was retrieved from a database established by the author, including prospectively collected management data, physiological data and information from brain biopsy specimens examined with light and electron microscopy. Individuals with definite iNPH were included together with control subjects who matched the definite iNPH cohort closest in gender and age. Patients with definite iNPH presented with abnormally elevated pulsatile intracranial pressure measured overnight. Cortical brain biopsies showed reduced expression of AQP4 at astrocytic endfeet both perivascular and toward neuropil. This was accompanied with reduced expression of the anchor molecule dystrophin (Dp71) at astrocytic perivascular endfeet, evidence of altered cellular metabolic activity in astrocytic endfoot processes (reduced number of normal and increased number of pathological mitochondria), and evidence of reactive changes in astrocytes (astrogliosis). Moreover, the definite iNPH subjects demonstrated in cerebral cortex changes in capillaries (reduced thickness of the basement membrane between astrocytic endfeet and endothelial cells and pericytes, and evidence of impaired blood-brain-barrier integrity). Abnormal changes in neurons were indicated by reduced post-synaptic density length, and reduced number of normal mitochondria in pre-synaptic terminals. In summary, definite iNPH is characterized by profound cellular changes at the glia-neurovascular interface, which probably reflect the underlying pathophysiology.
Collapse
Affiliation(s)
- Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- *Correspondence: Per Kristian Eide
| |
Collapse
|
3
|
Eidsvaag VA, Hansson HA, Heuser K, Nagelhus EA, Eide PK. Cerebral microvascular abnormalities in patients with idiopathic intracranial hypertension. Brain Res 2018; 1686:72-82. [PMID: 29477544 DOI: 10.1016/j.brainres.2018.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/16/2018] [Accepted: 02/13/2018] [Indexed: 01/01/2023]
Abstract
AIM Idiopathic intracranial hypertension (IIH) is characterized by symptoms indicative of increased intracranial pressure (ICP), such as headache and visual impairment. We have previously reported that brain biopsies from IIH patients show patchy astrogliosis and increased expression of the water channel aquaporin-4 (AQP4) at perivascular astrocytic endfeet. METHODS The present study was undertaken to investigate for ultrastructural changes of the cerebral capillaries in individuals with IIH. We examined by electron microscopy (EM) biopsies from the cortical parenchyma of 10 IIH patients and 8 reference subjects (patients, not healthy individuals), in whom tissue was retrieved from other elective and necessary brain surgeries (epilepsy, tumors or vascular diseases). IIH patients were diagnosed on the basis of typical clinical symptoms and abnormal intracranial pressure wave amplitudes during overnight ICP monitoring. RESULTS All 10 IIH patients underwent shunt surgery followed by favorable clinical outcome. EM revealed abnormal pericyte processes in IIH. The basement membrane (BM) showed more frequently evidence of degeneration in IIH, but neither the BM dimensions nor the pericyte coverage differed between IIH and reference tissue. The BM thickness increased significantly with increasing age. Reference individuals were older than IIH cases; observations may to some extent be age-related. CONCLUSION The present study disclosed marked changes of the cerebral cortical capillaries in IIH patients, suggesting that microvascular alterations are involved in the evolvement of IIH.
Collapse
Affiliation(s)
- Vigdis Andersen Eidsvaag
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway,; Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Hans-Arne Hansson
- Institute of Biomedicine, University of Gothenburg, Göteborg, Sweden
| | - Kjell Heuser
- Department of Neurology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Erlend A Nagelhus
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway,; Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway,.
| |
Collapse
|
4
|
Eidsvaag VA, Hansson HA, Heuser K, Nagelhus EA, Eide PK. Brain Capillary Ultrastructure in Idiopathic Normal Pressure Hydrocephalus: Relationship With Static and Pulsatile Intracranial Pressure. J Neuropathol Exp Neurol 2017; 76:1034-1045. [PMID: 29040647 DOI: 10.1093/jnen/nlx091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/19/2017] [Indexed: 01/08/2023] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a neurodegenerative disease of unknown cause. We investigated the morphology of capillaries in frontal cortex biopsies from iNPH patients and related the observations to overnight intracranial pressure (ICP) scores. A biopsy (0.9×10 mm) was taken from where the ICP sensor subsequently was inserted. Brain capillaries were investigated by electron microscopy of biopsies from 27 iNPH patients and 10 reference subjects, i.e. patients (not healthy individuals) without cerebrospinal fluid circulation disturbances, in whom normal brain tissue was removed as part of necessary neurosurgical treatment. Degenerating and degenerated pericyte processes were identified in 23/27 (85%) iNPH and 6/10 (60%) of reference specimens. Extensive disintegration of pericyte processes were recognized in 11/27 (41%) iNPH and 1/10 (10%) reference specimens. There were no differences in basement membrane (BM) thickness or pericyte coverage between iNPH and reference subjects. The pulsatile or static ICP scores did neither correlate with the BM thickness nor with pericyte coverage. We found increased prevalence of degenerating pericytes in iNPH while the BM thickness and pericyte coverage did not differ from the reference individuals. Observations in iNPH may to some extent be age-related since the iNPH patients were significantly older than the reference individuals.
Collapse
Affiliation(s)
- Vigdis Andersen Eidsvaag
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Faculty of Medicine; and Division of Physiology, Department of Molecular Medicine, GliaLab and Letten Centre, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Institute of Biomedicine, University of Gothenburg, Göteborg, Sweden; and Department of Neurology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Hans-Arne Hansson
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Faculty of Medicine; and Division of Physiology, Department of Molecular Medicine, GliaLab and Letten Centre, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Institute of Biomedicine, University of Gothenburg, Göteborg, Sweden; and Department of Neurology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Kjell Heuser
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Faculty of Medicine; and Division of Physiology, Department of Molecular Medicine, GliaLab and Letten Centre, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Institute of Biomedicine, University of Gothenburg, Göteborg, Sweden; and Department of Neurology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Erlend A Nagelhus
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Faculty of Medicine; and Division of Physiology, Department of Molecular Medicine, GliaLab and Letten Centre, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Institute of Biomedicine, University of Gothenburg, Göteborg, Sweden; and Department of Neurology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Per K Eide
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Faculty of Medicine; and Division of Physiology, Department of Molecular Medicine, GliaLab and Letten Centre, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Institute of Biomedicine, University of Gothenburg, Göteborg, Sweden; and Department of Neurology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| |
Collapse
|
5
|
Thomsen MS, Routhe LJ, Moos T. The vascular basement membrane in the healthy and pathological brain. J Cereb Blood Flow Metab 2017; 37:3300-3317. [PMID: 28753105 PMCID: PMC5624399 DOI: 10.1177/0271678x17722436] [Citation(s) in RCA: 273] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 06/21/2017] [Accepted: 06/28/2017] [Indexed: 12/24/2022]
Abstract
The vascular basement membrane contributes to the integrity of the blood-brain barrier (BBB), which is formed by brain capillary endothelial cells (BCECs). The BCECs receive support from pericytes embedded in the vascular basement membrane and from astrocyte endfeet. The vascular basement membrane forms a three-dimensional protein network predominantly composed of laminin, collagen IV, nidogen, and heparan sulfate proteoglycans that mutually support interactions between BCECs, pericytes, and astrocytes. Major changes in the molecular composition of the vascular basement membrane are observed in acute and chronic neuropathological settings. In the present review, we cover the significance of the vascular basement membrane in the healthy and pathological brain. In stroke, loss of BBB integrity is accompanied by upregulation of proteolytic enzymes and degradation of vascular basement membrane proteins. There is yet no causal relationship between expression or activity of matrix proteases and the degradation of vascular matrix proteins in vivo. In Alzheimer's disease, changes in the vascular basement membrane include accumulation of Aβ, composite changes, and thickening. The physical properties of the vascular basement membrane carry the potential of obstructing drug delivery to the brain, e.g. thickening of the basement membrane can affect drug delivery to the brain, especially the delivery of nanoparticles.
Collapse
Affiliation(s)
- Maj S Thomsen
- Laboratory of Neurobiology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Lisa J Routhe
- Laboratory of Neurobiology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Torben Moos
- Laboratory of Neurobiology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
6
|
Frič R, Pripp AH, Eide PK. Cardiovascular risk factors in Chiari malformation and idiopathic intracranial hypertension. Brain Behav 2017; 7:e00677. [PMID: 28523220 PMCID: PMC5434183 DOI: 10.1002/brb3.677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/04/2017] [Accepted: 02/10/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Both Chiari malformation type 1 (CMI, i.e., the idiopathic caudal ectopy of cerebellar tonsils into foramen magnum) and idiopathic intracranial hypertension (IIH) are characterized by reduced intracranial compliance (ICC) due to disturbed circulation of cerebrospinal fluid (CSF). An increasing body of evidence links cardiovascular disease to CSF circulation disturbances. The aim of this study was to explore whether the prevalence of cardiovascular risk factors in patients with CMI or IIH is higher than in the general population. MATERIALS AND METHODS Among the patients with CMI or IIH treated at our department during the period 2003-2014, we identified those with history of arterial hypertension (AH), myocardial infarction (MI), angina pectoris (AP), or diabetes mellitus (DM). For comparison with a control population, we retrieved information about the prevalence of AH, MI, AP, and DM among participants of the North-Trøndelag Health Study 3 (HUNT3). RESULTS Data from 48 CMI and 52 IIH cases were available. Compared to data from the 42,461 individuals participating in the HUNT3, we found increased prevalence of DM in male CMI as well as female IIH cases, and of AH in female IIH cases. Body mass index (BMI) was significantly increased in both female and male IIH cases. Prevalence of MI and AP in the CMI and IIH cohorts was extremely low and therefore not further studied. CONCLUSIONS This study provided evidence of an increased prevalence of DM in male CMI as well as female IIH cases and of AH in female IIH cases. Although requiring further exploration, these findings point to AH and DM as potential risk factors in the pathophysiology of CMI and IIH.
Collapse
Affiliation(s)
- Radek Frič
- Department of Neurosurgery Oslo University Hospital-Rikshospitalet Oslo Norway.,Faculty of Medicine University of Oslo Oslo Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology Oslo University Hospital Oslo Norway
| | - Per Kristian Eide
- Department of Neurosurgery Oslo University Hospital-Rikshospitalet Oslo Norway.,Faculty of Medicine University of Oslo Oslo Norway
| |
Collapse
|
7
|
Herson PS, Traystman RJ. Animal models of stroke: translational potential at present and in 2050. FUTURE NEUROLOGY 2014; 9:541-551. [PMID: 25530721 DOI: 10.2217/fnl.14.44] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Translation from basic science bench research in ischemic stroke to bedside treatment of patients suffering ischemic stroke remains a difficult challenge. Despite literally hundreds of compounds and interventions that provide benefit in experimental models of cerebral ischemia, efficacy in humans remains to be demonstrated. The reasons for failure to translate the extensive positive basic science findings to successful clinical trials have been the focus of discussion for years. Some attribute the failure to flaws in clinical trial design, others question the predictive value of current animal models and some question the quality of preclinical data. It is likely that a combination of all these shortcomings have ultimately led to the failure. The purpose of this review is to analyze the commonly used animal models used in the field today, provide a framework for understanding the current state of basic science research in the ischemic stroke field and discuss a path forward.
Collapse
Affiliation(s)
- Paco S Herson
- Department of Pharmacology, University of Colorado Denver, Anschutz Medical Campus, 12800 E 19th Avenue, Aurora, CO 80045, USA ; Department of Anesthesiology, University of Colorado Denver, Anschutz Medical Campus, 12800 E 19th Avenue, Aurora, CO 80045, USA
| | - Richard J Traystman
- Department of Pharmacology, University of Colorado Denver, Anschutz Medical Campus, 12800 E 19th Avenue, Aurora, CO 80045, USA ; Department of Anesthesiology, University of Colorado Denver, Anschutz Medical Campus, 12800 E 19th Avenue, Aurora, CO 80045, USA
| |
Collapse
|
8
|
Hou Q, Zuo Z, Michel P, Zhang Y, Eskandari A, Man F, Gao Q, Johnston KC, Wintermark M. Influence of Chronic Hyperglycemia on Cerebral Microvascular Remodeling. Stroke 2013; 44:3557-60. [DOI: 10.1161/strokeaha.113.003150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Qinghua Hou
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Zhiyi Zuo
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Patrik Michel
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Yanrong Zhang
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Ashraf Eskandari
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Fengyuan Man
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Qingcun Gao
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Karen C. Johnston
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| | - Max Wintermark
- From the Neuroradiology Division, Department of Radiology (Q.H., Y.Z., F.M., M.W.), Department of Anesthesiology (Z.Z.), and Department of Neurology (K.C.J.), University of Virginia, Charlottesville, VA; Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, China (Q.H., Q.G.); Department of Neurology (P.M., A.E.), and Department of Radiology (M.W.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Ultrasound, the Union
| |
Collapse
|