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Ontsi Obame FL, Elmi SM, Dokponou YCH, Imbunhe N, El Attari S, Laaguili J, Abderrahmane H, Mohcine S, Gazzaz M. Primary tuberculous pyogenic ventriculitis in an immunocompetent patient: A case report. Surg Neurol Int 2024; 15:293. [PMID: 39246783 PMCID: PMC11380897 DOI: 10.25259/sni_263_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/16/2024] [Indexed: 09/10/2024] Open
Abstract
Background Although tuberculosis (TB) of the central nervous system is quite common, tuberculous pyogenic ventriculitis is not only rare; it is a devastating disease in an immunocompetent patient if left untreated. Case Description We present the case of a 43-year-old man who underwent successful treatment for tuberculous pyogenic ventriculitis that presented with meningeal syndrome and loss of consciousness. Conclusion Tuberculous pyogenic ventriculitis is a rare manifestation of intracranial tuberculous infection. Despite advances in imaging techniques, the diagnosis of intraventricular TB is essentially biological.
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Affiliation(s)
- Fresnel Lutèce Ontsi Obame
- Department of Neurosurgery, Mohammed V Military Training Hospital, Mohammed V Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Saad Moussa Elmi
- Department of Neurosurgery, Mohammed V Military Training Hospital, Mohammed V Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Yao Christian Hugues Dokponou
- Department of Neurosurgery, Mohammed V Military Training Hospital, Mohammed V Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Napoleão Imbunhe
- Department of Neurosurgery, Mohammed V Military Training Hospital, Mohammed V Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Soufiyan El Attari
- Department of Bacteriology, Mohammed V Military Training Hospital, Mohammed V Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Jawad Laaguili
- Department of Neurosurgery, Mohammed V Military Training Hospital, Mohammed V Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Housni Abderrahmane
- Department of Neurosurgery, Mohammed V Military Training Hospital, Mohammed V Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Salami Mohcine
- Department of Neurosurgery, Mohammed V Military Training Hospital, Mohammed V Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Miloudi Gazzaz
- Department of Neurosurgery, Mohammed V Military Training Hospital, Mohammed V Faculty of Medicine and Pharmacy, Rabat, Morocco
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Letchuman V, Guillotte AR, Lundy PA, Dharia A, Lakis NS, Camarata PJ. Intracranial tuberculoma: a rare complication of extrapulmonary tuberculosis. Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE2291. [PMID: 35855351 PMCID: PMC9257396 DOI: 10.3171/case2291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/15/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Intracranial tuberculomas are rare entities commonly seen only in low- to middle-income countries where tuberculosis remains endemic. Furthermore, following adequate treatment, the development of intracranial spread is uncommon in the absence of immunosuppression. OBSERVATIONS A 22-year-old man with no history of immunosuppression presented with new-onset seizures in the setting of miliary tuberculosis status post 9 months of antitubercular therapy. Following a 2-month period of remission, he presented with new-onset tonic-clonic seizures. Magnetic resonance imaging demonstrated interval development of a mass concerning for an intracranial tuberculoma. After resection, pathological analysis of the mass revealed caseating granulomas within the multinodular lesion, consistent with intracranial tuberculoma. The patient was discharged after the reinitiation of antitubercular medications along with a steroid taper. LESSONS To the best of the authors’ knowledge, this case represents the first instance of intracranial tuberculoma occurring after the initial resolution of a systemic tuberculosis infection. The importance of retaining a high level of suspicion when evaluating these patients for seizure etiology is crucial because symptoms are rapidly responsive to resection of intracranial tuberculoma masses. Furthermore, it is imperative for surgeons to recognize the isolation steps necessary when managing these patients within the operating theater and inpatient settings.
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Affiliation(s)
| | | | | | | | - Nelli S. Lakis
- Pathology, University of Kansas Medical Center, Kansas City, Kansas
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3
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Benyaich Z, Hajhoui F, Laghmari M, Ghannane H, Benali SA. Ruptured intraventricular tuberculous brain abscess mimicking cystic neoplasm: a case report. Pan Afr Med J 2021; 39:122. [PMID: 34527138 PMCID: PMC8418180 DOI: 10.11604/pamj.2021.39.122.29369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
Central nervous system (CNS) tuberculosis is a potentially life-threatening condition that may manifest in different forms and simulate other pathologies. It rarely involves the ventricles and the occurrence of primary intraventricular tuberculous brain abscess (TBA) has exceptionally been reported. As far as we know, ruptured intraventricular TBA has not been described before. An immunocompetent 56-years-old man was admitted for sub-acute intracranial hypertension with behaviour disorders. Cranial magnetic resonance imaging (MRI) showed a cystic lesion of the third ventricle containing fluid-fluid level with biventricular hydrocephalus and debris in the occipital horns. A ruptured cystic neoplasm was first considered. The patient underwent surgery via a right transcortical transventricular approach, combining both microscope and endoscope. The puncture of the lesion brought pus and the Ziehl-Neelson (ZN) staining demonstrated acid-fast bacilli. Intraventricular tuberculous abscess is an extremely rare condition that can take an unusual radiological appearance. This observation highlights the consideration of tuberculosis within the list of differential diagnosis of intraventricular cystic lesions in immunocompetent hosts.
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Affiliation(s)
- Zakariae Benyaich
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Farouk Hajhoui
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Mehdi Laghmari
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, University Hospital Center Mohammed VI of Marrakech, Marrakech, Morocco.,Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Diaz-Arias LA, Pardo CA, Probasco JC. Infectious Encephalitis in the Neurocritical Care Unit. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00623-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Meegada S, Gyamfi R, Muppidi V, Dandu V, Challa T. Multiple Intracranial Tuberculomas with an Intra-medullary Spinal Cord Tuberculoma in a Pediatric Patient. Cureus 2020; 12:e7248. [PMID: 32292663 PMCID: PMC7152571 DOI: 10.7759/cureus.7248] [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: 03/02/2020] [Accepted: 03/12/2020] [Indexed: 11/10/2022] Open
Abstract
Central nervous system (CNS) tuberculosis (TB), caused by Mycobacterium tuberculosis (MT), is a severe form of TB, which presents as meningitis, cerebritis, abscesses, spinal tuberculous arachnoiditis, and rarely tuberculomas. CNS TB is prevalent in the underdeveloped or developing world and is common in malnourished, alcoholics, children, young adults, immunocompromised, and cancer patients. Intracranial tuberculomas (ICT) can present with symptoms and signs of focal neurological deficits with or without systemic manifestations. ICT is the least common presentation of CNS TB. Medical management with anti-TB drugs and steroids is the mainstay of treatment, while surgical intervention is usually reserved for refractory cases. Here, we present the case of a 10-year-old Indian American girl with headaches, diplopia, fever, and neck pain diagnosed with ICT and intramedullary spinal cord tuberculoma.
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Affiliation(s)
- Sreenath Meegada
- Internal Medicine, The University of Texas Health Science Center/Christus Good Shepherd Medical Center, Longview, USA
| | | | | | - Vasuki Dandu
- Neurology, Baptist Health Medical Center, Little Rock, USA
| | - Tejo Challa
- Internal Medicine, The University of Texas Health Science Center/Christus Good Shepherd Medical Center, Longview, USA
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6
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Management of adult infectious encephalitis in metropolitan France. Med Mal Infect 2017; 47:206-220. [PMID: 28336304 DOI: 10.1016/j.medmal.2017.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 02/06/2023]
Abstract
Infectious encephalitis is a severe disease leading to a high mortality and morbidity. The most frequent causes include Herpes simplex virus, Varicella Zoster virus, Listeria monocytogenes, and Mycobacterium tuberculosis. Urgent treatment is required (anti-infective therapy and nonspecific supportive care). The aim of this study was to define treatment strategy, empirical and after microbiological documentation at 48hours, through a systematic literature review.
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Xu B, Zhang Y, Yu J. Brainstem tuberculous abscesses successfully treated by microsurgical excision: A case report and review of the literature. Oncol Lett 2017; 13:2708-2712. [PMID: 28454455 PMCID: PMC5403498 DOI: 10.3892/ol.2017.5782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 02/14/2017] [Indexed: 12/27/2022] Open
Abstract
In patients without systemic manifestations of tuberculosis, isolated brainstem tuberculous abscesses are infrequently observed. The present study reports a rare case of two cystic tuberculous abscesses involving the dorsal aspect of the medulla oblongata in an otherwise healthy 14-year-old Chinese girl, whose primary complaint was respiratory distress. These lesions were successfully treated using a microsurgical excision approach and anti-tuberculosis therapy. Although rare, tuberculous abscesses should be considered in the differential diagnosis of isolated cystic brainstem lesions. The results of the present study indicate that microsurgery, when combined with anti-tuberculosis therapy, is an effective and safe method to treat brainstem tuberculous abscesses.
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Affiliation(s)
- Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yandong Zhang
- Department of Rheumatology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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A rare case of central nervous system tuberculosis. Case Rep Infect Dis 2014; 2014:186030. [PMID: 25478256 PMCID: PMC4248556 DOI: 10.1155/2014/186030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 10/10/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022] Open
Abstract
Intracranial abscess is an extremely rare form of central nervous system (CNS) tuberculosis (TB). We describe a case of central nervous system tuberculous abscess in absence of human immunodeficiency virus (HIV) infection. A 82-year-old Middle Eastern male from Yemen was initially brought to the emergency room due to altered mental status and acute renal failure. Cross-sectional imaging revealed multiple ring enhancing lesions located in the left cerebellum and in bilateral frontal lobe as well as in the inferior parietal lobe on the left. The patient was placed on an empiric antibiotic regimen. Preliminary testing for infectious causes was negative. Chest radiography and CT of chest showed no positive findings. He was not on any immunosuppressive medications and human immunodeficiency virus (HIV) enzyme immunoassay (EIA) test was negative. A subsequent MRI one month later showed profound worsening of the lesions with increasing vasogenic edema and newly found mass effect impinging on the fourth ventricle. Brain biopsy showed focal exudative cerebellitis and inflamed granulation tissue consistent with formation of abscesses. The diagnosis of CNS TB was finally confirmed by positive acid-fast bacilli (AFB) cultures. The patient was started on standard tuberculosis therapy but expired due to renal failure and cardiac arrest.
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9
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Psimaras D, Bonnet C, Heinzmann A, Cárdenas G, Hernández José Luis S, Tungaria A, Behari S, Lacrois D, Mokhtari K, Karantoni E, Sokrab Tag E, Idris Mohamed N, Sönmez G, Caumes E, Roze E. Solitary tuberculous brain lesions: 24 new cases and a review of the literature. Rev Neurol (Paris) 2014; 170:454-63. [DOI: 10.1016/j.neurol.2013.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/11/2013] [Accepted: 12/03/2013] [Indexed: 11/29/2022]
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10
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Ting PLC, Norton R. Central nervous system tuberculosis: a disease from Papua New Guinea in North Queensland. J Paediatr Child Health 2013; 49:E193-8. [PMID: 23480051 DOI: 10.1111/jpc.12107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2012] [Indexed: 11/30/2022]
Abstract
AIM To describe cases of confirmed central nervous system (CNS) tuberculosis seen at the major tertiary referral centre of North Queensland over a 10-year period. METHODS This is a retrospective case series-based study of all cases of proven Mycobacterium tuberculosis infection of the CNS presenting to a major tertiary referral centre of North Queensland between 2000 and 2010. RESULTS Five cases of confirmed CNS tuberculosis were identified over the 10-year period with two deaths. All were from Papua New Guinea with a mean age of 7 years. Imaging and early microbiological diagnosis was critical in making the diagnosis. HIV infection was not a contributing factor. Multidrug resistance was inferred or confirmed in two cases. CONCLUSIONS CNS tuberculosis is a disease being increasingly seen in North Queensland among children from Papua New Guinea. Anticipation of multidrug resistance is important in the immediate management of suspected cases.
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12
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Kaeser MA, Kettner NW, Albastaki U, Kotb HA, Eldesouky IM, Pierre-Jerome C. Tuberculous Spondylitis Presenting as Severe Chest Pain. Clin Pract 2012; 2:e42. [PMID: 24765441 PMCID: PMC3981296 DOI: 10.4081/cp.2012.e42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 02/16/2012] [Accepted: 03/01/2012] [Indexed: 11/23/2022] Open
Abstract
This case report describes a 32-year-old male who presented to an emergency department with severe chest pain and a history of cough, fever, night sweats, loss of appetite and weight. Chest radiography revealed a left upper lobe consolidation and multiple compression deformities in the thoracic spine. Magnetic resonance imaging demonstrated significant kyphosis and vertebral plana at two thoracic levels. Anterior compression of the spinal cord and adjacent soft tissue masses were also noted.
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13
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Nelson CA, Zunt JR. Tuberculosis of the central nervous system in immunocompromised patients: HIV infection and solid organ transplant recipients. Clin Infect Dis 2011; 53:915-26. [PMID: 21960714 DOI: 10.1093/cid/cir508] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Central nervous system (CNS) tuberculosis (TB) is a devastating infection with high rates of morbidity and mortality worldwide and may manifest as meningitis, tuberculoma, abscess, or other forms of disease. Immunosuppression, due to either human immunodeficiency virus infection or solid organ transplantation, increases susceptibility for acquiring or reactivating TB and complicates the management of underlying immunosuppression and CNS TB infection. This article reviews how immunosuppression alters the clinical presentation, diagnosis, treatment, and outcome of TB infections of the CNS.
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Affiliation(s)
- Christina A Nelson
- Department of Neurology, Global Health, Medicine, and Epidemiology, University of Washington School of Medicine, Seattle, Washington, USA
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14
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Menon S, Bharadwaj R, Chowdhary AS, Kaundinya DV, Palande DA. Tuberculous brain abscesses: Case series and review of literature. J Neurosci Rural Pract 2011; 2:153-7. [PMID: 21897678 PMCID: PMC3159351 DOI: 10.4103/0976-3147.83581] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Tuberculous brain abscess (TBA) is a rare but serious condition. It resembles a pyogenic brain abscess clinically and radiologically and poses a problem in diagnosis and treatment. A final diagnosis is established by smear or culture demonstration of acid fast bacilli (AFB) within the abscess. Here, we report four such cases in our five-year study on brain abscesses, along with the different diagnostic modalities used. MATERIALS AND METHODS A total of 75 brain abscess pus specimens were collected during neurosurgery, either by burr hole or by craniotomy. These specimens were further subjected to Gram stain, Ziehl-Neelsen (ZN) stain, and conventional microbiological culture. Only those cases which showed presence of AFB on ZN stain along with the growth of Mycobacterium tuberculosis were considered as TBAs. Such TBA cases were further presented along with their In vitro Proton Magnetic Resonance (MR) Spectroscopic findings. RESULTS Of these four patients, three were males. Though this condition is more commonly seen in immunocompromised patients, three of the patients in this study were immunocompetent. All the four pus specimens showed presence of AFB in the ZN stain. Three of them grew M. tuberculosis as sole isolate. The fourth case was of concomitant tuberculous and pyogenic brain abscess. In vitro Proton MR spectroscopy of the pus specimens showed absence of multiple amino acids at 0.9 ppm, which was found to be hallmark of TBA. One patient died of four. CONCLUSIONS TBA always poses a diagnostic dilemma. ZN stain and conventional microbiological culture for Mycobacteria always help to solve this dilemma. In vitro Proton MR Spectroscopy also seems to have the diagnostic utility.
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Affiliation(s)
- Sarala Menon
- Department of Microbiology, Grant Medical College and Sir J.J. Hospital, Mumbai, India
| | - Renu Bharadwaj
- Department of Microbiology, Grant Medical College and Sir J.J. Hospital, Mumbai, India
| | - AS Chowdhary
- Department of Microbiology, Grant Medical College and Sir J.J. Hospital, Mumbai, India
| | - DV Kaundinya
- Department of Microbiology, Grant Medical College and Sir J.J. Hospital, Mumbai, India
| | - DA Palande
- Department of Neurosurgery, Grant Medical College and Sir J.J. Hospital, Mumbai, India
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Jung MY, Ju DY, Lee HA, Jeong WS, Yang JY, Yeom JS. A Case of Bain Abscess caused by Mycobacterium intracellurare. Infect Chemother 2011. [DOI: 10.3947/ic.2011.43.4.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mi-Yeon Jung
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok-Yun Ju
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Ah Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Shin Jeong
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Young Yang
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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