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Peyman A, Rahimi B, Pourmahdi-Boroujeni M, Mirmohammadkhani M, Aslani A, Soleimani M, Abounoori M, Pourazizi M. Predisposing Factors and Clinical-Microbiological Profile of Neonatal Corneal Ulcer: A Systematic Review and Analysis. Ocul Immunol Inflamm 2024:1-12. [PMID: 38709200 DOI: 10.1080/09273948.2024.2346246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/18/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To provide a comprehensive overview of predisposing factors and clinical-microbiological profile of neonatal corneal ulcer. METHODS The literature search was undertaken in PubMed, SCOPUS, Embase, Web of Science, and Google Scholar databases on published papers from inception to May 31, 2023. The included articles were independently assessed for methodological quality using a Joanna Briggs Institute checklist. Weighted analysis was utilized, assigning a weight of one to each case report and a weight equivalent to the sample size for the case series/original studies. RESULT We included 34 relevant case reports/series and one original study. Seventy-four neonates were enrolled with a boy-to-girl ratio of 1.3:1 and a median age of 17 days (1-27 days). Prematurity and neonatal intensive care unit (NICU) care (21.6%), congenital horizontal tarsal kink (13.5%), neonatal herpes infection (13.5%), congenital entropion (5.4%), and jaundice (5.4%) were the most common potential risk factors and coexisting conditions. Microbiology evaluation showed positive results in 53.8% (21/39 cases). Viral and bacterial infections were the most common cause, followed by fungal infections. Herpes virus (18.9%), Pseudomonas aeruginosa (18.9%%) and Staphylococcus epidermidis (6.7%) were the most prevalent causative agents. Negative microbiology was significantly more common in neonates with structural abnormalities (14.9%) compared to others (6.8%) (p = 0.01). CONCLUSION Based on the findings of reported studies, this systematic review has increased awareness of the risk factors and etiologies that lead to developing corneal ulcers in neonates.
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Affiliation(s)
- Alireza Peyman
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrouz Rahimi
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | | | - Majid Mirmohammadkhani
- Department of Epidemiology and Biostatistics, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Asieh Aslani
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Soleimani
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago College of Applied Health Sciences, Chicago, Illinois, USA
| | - Mahdi Abounoori
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Pourazizi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
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Mori F, Saretta F, Liotti L, Giovannini M, Castagnoli R, Arasi S, Barni S, Mastrorilli C, Pecoraro L, Caminiti L, Marseglia GL, Barbaud A, Novembre E. Linear Immunoglobulin a Bullous Dermatosis in Children. Front Pediatr 2022; 10:937528. [PMID: 35874598 PMCID: PMC9304959 DOI: 10.3389/fped.2022.937528] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023] Open
Abstract
Linear Immunoglobulin A Bullous Disease (LABD) is a rare dermatosis whose pathomechanisms are not yet completely understood. LABD has different features characterizing adults and children in terms of potential triggers, clinical manifestations, and prognosis. The aim of the present study is to review all neonatal and pediatric cases of LABD and summarize the major characteristics. Childhood LABD is mainly idiopathic with a benign prognosis. Neonatal cases are difficult to differentiate from infectious diseases and usually have a poor prognosis. Drugs are one of the possible triggers that can activate autoimmune responses through antigen mimicry and epitope spreading as well as different stimuli (e.g., infections, inflammatory diseases, trauma). The gold standard for the diagnosis is based on direct immunofluorescence. Prognosis is generally favorable but often depends on the prompt dermatological diagnosis, treatment and follow-up guaranteed by a multidisciplinary team, including pediatricians for this group of age.
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Affiliation(s)
- Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Lucia Liotti
- Department of Pediatrics, Salesi Children's Hospital, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Riccardo Castagnoli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Carla Mastrorilli
- Pediatric Unit and Emergency, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, Bari, Italy
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Lucia Caminiti
- Department of Human Pathology in Adult and Development Age “Gaetano Barresi”, Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, Messina, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Annick Barbaud
- Sorbonne Universités, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France
| | - Elio Novembre
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
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Ashton R, Fassihi H. Pediatric Autoimmune Bullous Disease: A Literature Review and Update on Management. Pediatr Rev 2022; 43:309-321. [PMID: 35641451 DOI: 10.1542/pir.2021-005125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pediatric autoimmune bullous disease is a rare group of blistering skin disorders in children that result from autoimmunity against intercellular and basement membrane antigens in the skin and mucous membranes. Most pediatric cases are treated with oral corticosteroids or longer-term immunosuppressants such as azathioprine or mycophenolate mofetil. Immunomodulating drugs such as rituximab are increasingly being considered as options for refractory disease.
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Affiliation(s)
| | - Hiva Fassihi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, England
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Nanda A, Lazarevic V, Rajy JM, Almasry IM, AlSabah H, AlLafi A. Spectrum of autoimmune bullous diseases among children in Kuwait. Pediatr Dermatol 2021; 38:50-57. [PMID: 33043506 DOI: 10.1111/pde.14368] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/28/2020] [Accepted: 08/20/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Autoimmune bullous diseases (AIBD) are rare among children. The data describing the overall spectrum and prognosis of pediatric AIBD (pAIBD) are scarce, and there are no established treatment guidelines. OBJECTIVES The present study examined the spectrum, clinical characteristics, and long-term prognosis of pAIBD in a tertiary care pediatric dermatology unit. METHODS Retrospective records of all pAIBD cases (<18 years) registered over a span of 28 years were analyzed. RESULTS Records of 23 cases of pAIBD, including 16 boys and 7 girls, were reviewed. They constituted 8.5% of total AIBD patients from all age groups. Ninety-one percent of patients were of Arab ethnicity. Linear IgA bullous dermatosis was the most prevalent AIBD followed by bullous pemphigoid, bullous lupus erythematosus, and pemphigus variants (pyostomatitis-pyodermatitis vegetans and neonatal pemphigus). The mean age of onset and diagnosis was 6.4 and 7.7 years, respectively. Systemic treatments, including systemic corticosteroids and dapsone, were required in most cases. Intravenous immunoglobulin G (IVIG) was also utilized as second-line therapy. The mean follow-up period was 76 months with 90% of the patients in complete remission. CONCLUSIONS AIBD pose a great challenge among children both in diagnosis and treatment. This study highlights the ethnic variability and underscores the need for additional similar, international studies to achieve a better understanding of the burden related to pAIBD and help establish treatment guidelines.
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Affiliation(s)
- Arti Nanda
- As'ad Al-Hamad Dermatology Center, Salmiya, Kuwait
| | | | - Jihan M Rajy
- As'ad Al-Hamad Dermatology Center, Salmiya, Kuwait
| | | | | | - Atlal AlLafi
- As'ad Al-Hamad Dermatology Center, Salmiya, Kuwait
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5
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Varo R, Fernández-Luis S, Sitoe A, Bassat Q. Suspected case of chronic bullous disease of childhood in a rural area of Southern Mozambique. BMJ Case Rep 2017; 2017:bcr-2016-218315. [PMID: 28232374 DOI: 10.1136/bcr-2016-218315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rosauro Varo
- Instituto de Salud Global Barcelona, Barcelona, Spain.,Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
| | | | - Antonio Sitoe
- Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
| | - Quique Bassat
- Instituto de Salud Global Barcelona, Barcelona, Spain.,Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain
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Abstract
Background: Autoimmune bullous disorders (AIBDs) are a heterogeneous group of diseases which are rarely seen in children. Studies concerning the immunobullous diseases in pediatric patients are scarce. Aims and Objectives: In this study, we aimed to investigate the clinical features and treatment outcomes of AIBDs in children. Materials and Methods: The electronic records of the patients in our AIBDs outpatient clinic were retrospectively reviewed. All cases diagnosed before the age of 16 years were included in the analysis of clinical features, treatment outcomes, and follow-up data. Results: Of the 196 patients with immunobullous diseases, 9 (4.6%) were diagnosed before the age of 16 years. Mean age of the patients at the time of diagnosis was 7.72 ± 5.66 years. Among nine patients, linear immunoglobulin A disease (LAD), pemphigus vulgaris (PV), and bullous pemphigoid (BP) were seen in 5, 2, and 2 children, respectively. All patients were treated with at least two systemic agents (including methylprednisolone, dapsone, methotrexate, salazopyrine, intravenous Ig [IVIg], and rituximab) leading to clinical remission in all of them after a mean period of 31.77 ± 27.99 months. Conclusion: In line with earlier studies, LAD was the most common immunobullous disease and in general, associated with a favorable response to dapsone. This study was noteworthy in that the patients with PV and BP demonstrated a relatively more recalcitrant course, requiring rituximab and IVIg for remission, respectively. Overall, patients had a good prognosis.
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Affiliation(s)
- Andac Salman
- Department of Dermatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Burak Tekin
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Deniz Yucelten
- Department of Dermatology, School of Medicine, Marmara University, Istanbul, Turkey
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7
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Chen CB, Cheng CY, Kuo TT, Yang CH, Chung WH, Ou LS, Shih IH. Childhood bullous pemphigoid-A case report. DERMATOL SIN 2016. [DOI: 10.1016/j.dsi.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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8
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A Progressive Blistering Eruption in a 5-Month-Old Male Infant. Am J Dermatopathol 2016; 38:634-5. [DOI: 10.1097/dad.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Williams A, Whitley-Williams P, Cha J, Pappert A. A Case of Bullous Pemphigoid in an Infant. Clin Pediatr (Phila) 2016; 55:567-71. [PMID: 26603586 DOI: 10.1177/0009922815618488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Jisun Cha
- Rutgers University, Somerset, NJ, USA
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10
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The “Pearls” of Multidisciplinary Team: Conquering the Uncommon Rosette Rash. Case Rep Pediatr 2016; 2016:5328603. [PMID: 28070436 PMCID: PMC5187467 DOI: 10.1155/2016/5328603] [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: 07/25/2016] [Accepted: 11/16/2016] [Indexed: 11/18/2022] Open
Abstract
Linear IgA disease of childhood (LAD) also known as chronic bullous disease of childhood is an autoimmune disease with IgA deposition at the basement membrane zone leading to a vesiculobullous rash. It has a clinical appearance which frequently is described as resembling “strings of pearls” or rosette-like. Diagnosis is usually clinical but sometimes biopsy is required. Dapsone is widely considered to be the first line therapy in the treatment of LAD. A 5-year-old girl presented with 4-day history of a widespread painful rash and pyrexia. The rash transformed into painful blisters. A recent contact with chickenpox was present. She remained apyrexial but hemodynamically stable and was treated as chickenpox patient with secondary infection. Due to persistent symptoms after repeated attendance she was reviewed by Dermatology team and diagnosed with linear IgA disease also known as chronic bullous disease of childhood. This was based on the presence of blistering rash with rosette appearance and string of pearl lesions. The clinical features of LAD can be difficult to distinguish from more common skin infections. Benefiting from the experience of other multidisciplinary teams can sometimes be a game changer and can lead to the correct diagnosis and treatment.
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11
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Kong YL, Lim YL, Chandran NS. Retrospective Study on Autoimmune Blistering Disease in Paediatric Patients. Pediatr Dermatol 2015; 32:845-52. [PMID: 26391853 DOI: 10.1111/pde.12684] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Autoimmune blistering diseases (AIBDs) are rare in children and their prevalence in Singapore is unclear. We aimed to investigate the clinical and immunopathologic characteristics of children diagnosed with AIBDs in Singapore. MATERIALS AND METHODS The clinical and histology databases at the National Skin Centre in Singapore were searched to identify patients younger than 18 years old diagnosed with an AIBD from January 1, 1998, through December 31, 2012. Patient demographic characteristics, presentation, triggers, investigations, treatments, and disease course were analyzed. RESULTS Twelve patients with AIBDs were identified; five (41.7%) had linear immunoglobulin A disease (LAD); two (16.7%) each had pemphigus vulgaris (PV), bullous pemphigoid, and bullous systemic lupus erythematosus; and one (8.3%) had pemphigus foliaceus. Four (33.3%) were female and eight (66.7%) male. The mean age of onset was 8.7 years (range 2-17 years). Most patients were treated with steroids and adjuvant immunosuppressants. Intravenous rituximab was used effectively in a patient with recalcitrant PV. The mean follow-up was 2.35 years (range 0.17-7.33 years). As of the last follow-up, four (33.3%) patients were in complete remission off therapy, two (16.7%) were in complete remission on therapy, four (33.3%) were in partial remission on therapy, and two (16.7%) were lost to follow-up. CONCLUSION Consistent with the existing literature, our study shows that LAD is the most common cause of AIBDs in children. Although common in the West, dermatitis herpetiformis was not identified in the current study. Intravenous rituximab may be considered in recalcitrant childhood PV, but vigilant monitoring for side effects is crucial. Immunohistopathologic evaluation is important and repeat biopsies may be of value in patients with atypical disease courses.
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Affiliation(s)
- Yan Ling Kong
- Department of Dermatology, National Skin Centre, Singapore, Singapore
| | - Yen Loo Lim
- Department of Dermatology, National Skin Centre, Singapore, Singapore
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12
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Buckley G, Belessiotis K, Schim van der Loeff I, Jada K, Hill VA. An 18-month-old boy with a widespread bullous eruption. Arch Dis Child 2015; 100:295. [PMID: 25341554 DOI: 10.1136/archdischild-2014-307050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Gemma Buckley
- Department of Paediatrics, Barnet Hospital, Royal Free London Foundation NHS Trust, Barnet, Hertfordshire, UK
| | | | | | - Krishna Jada
- Department of Paediatrics, Barnet Hospital, Royal Free London Foundation NHS Trust, Barnet, Hertfordshire, UK
| | - Virginia A Hill
- Department of Dermatology, Barnet Hospital, Royal Free London NHS Foundation Trust, Barnet, Hertfordshire, UK
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13
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Sárdy M, Kasperkiewicz M. Bullöse Autoimmunkrankheiten bei Kindern. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3085-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Current World Literature. Curr Opin Rheumatol 2013; 25:275-83. [DOI: 10.1097/bor.0b013e32835eb755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Siqueira-Neto JI, Sales PMG, Sobreira EST, Limeira AM, Araujo HB, Dos Santos JV, de Castro JDV. Vascular cognitive impairment in Pemphigus vulgaris: A case report. Dement Neuropsychol 2012; 6:192-195. [PMID: 29213796 PMCID: PMC5618969 DOI: 10.1590/s1980-57642012dn06030014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pemphigus vulgaris is a systemic auto-immune medical condition
that mainly manifests with changes in skin and vasculopathy. This is a case
report of a 69-year-old male with confirmed histopathologic diagnosis of
Pemphigus vulgaris presenting ulterior Cognitive
Impairment, mostly in executive function. The patient was treated using
steroids, immunomodulatory therapy, fluoxetine and galantamine.
Neuropsychological testing and magnetic resonance (MRI) were performed. This is
the first report of correlational cognitive impairment with Pemphigus
vulgaris in the literature. Physicians should be aware of vascular
causes for cognitive impairment in patients presenting auto-immune
conditions.
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Affiliation(s)
- José Ibiapina Siqueira-Neto
- MD, PhD, Associate Professor of Neurology in the Clinical Medicine Department of Federal University of Ceará, Fortaleza CE, Brazil
| | | | | | - Aline Miranda Limeira
- MD, Medical Resident of Neurology, Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza CE, Brazil
| | - Heline Bessa Araujo
- MD, Medical Resident of Neurology, Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza CE, Brazil
| | - Júnia Vieira Dos Santos
- Medical Student, Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza CE, Brazil
| | - José Daniel Vieira de Castro
- MD, PhD, Adjunct Professor of Neuroradiology in the Clinical Medicine Department of Federal University of Ceará, Fortaleza CE, Brazil
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