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Huang LJ, Jiao JF, He Q, Luo JW, Guo Y. Ultrafast power Doppler imaging for ischemic encephalopathy: A case report. World J Clin Cases 2023; 11:7640-7646. [DOI: 10.12998/wjcc.v11.i31.7640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/26/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Severely elevated intracranial pressure due to various reasons, such as decreased cerebral perfusion, can lead to devastating neurological outcomes, such as brain herniation. Decompression craniectomy is a life-saving procedure that is commonly performed for such a critical situation, but the changes in cerebral microvessels after brain herniation and decompression are unclear. Ultrafast power Doppler imaging (uPDI) is a new microvascular imaging technology that utilizes high frame rate plane/diverging wave transmission and advanced clutter filters. uPDI significantly improves Doppler sensitivity and can detect microvessels, which are usually invisible using traditional ultrasound Doppler imaging.
CASE SUMMARY In this report, uPDI was used for the first time to observe the brain blood flow of a hypoperfusion area in a 4-year-old girl who underwent decompression craniectomy due to refractory intracranial hypertension (ICP) after malignant brain tumor surgery. B-mode imaging was used to verify the increased densities of the cerebral cortex and basal ganglia that were observed by computed tomography.
CONCLUSION uPDI showed the local blood supplies and anatomical structures of the patient after decompressive craniectomy. uPDI is potentially a more intuitive and noninvasive method for evaluating the effects of severe ICP on cerebral microvessels.
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Affiliation(s)
- Li-Jie Huang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Jian-Feng Jiao
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Medicine, Tsinghua University, Beijing 102218, China
| | - Qiong He
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Jian-Wen Luo
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Yi Guo
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Medicine, Tsinghua University, Beijing 102218, China
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Lebedeva ER, Gurary NM, Olesen J. Diagnosis of Migrainous Infarction: A Case Report and Analysis of Previously Published Cases. Diagnostics (Basel) 2023; 13:2502. [PMID: 37568864 PMCID: PMC10416890 DOI: 10.3390/diagnostics13152502] [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: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Migrainous infarction (MI) is a rare disorder. The precise diagnostic criteria for this diagnosis have been available in the International Classification of Headache Disorders (ICHD) since 1988, but many cases do not fulfil these criteria. This paper describes a good example of MI and analyzes previously published case reports. We report a very special case of MI in an 18-year-old woman who had a recurrent episode of migraine with a similar aura with numbness of the right arm and speech disturbances which had an unusually long duration (>120 min). On admission to the headache centre "Europe-Asia", she complained of slowness of speech and problems with choice of words. An MRI showed acute lacunar infarcts in the left parietal subcortical area. Ischemic infarcts were localized in a relevant area on the left side and the aura symptoms were right-sided. The patient, therefore, fulfilled the ICHD-3 diagnostic criteria for "Migrainous infarction". An analysis of 35 previously published articles with case reports about MI showed that 22 did not meet the diagnostic criteria of the ICHD for migrainous infarction. Using all this, we developed diagnostic recommendations for migrainous infarction which can help to improve the quality of diagnosis when used together with the diagnostic criteria of the ICHD for migrainous infarction.
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Affiliation(s)
- Elena R. Lebedeva
- Department of Neurology, The Ural State Medical University, 620028 Yekaterinburg, Russia
- International Headache Centre “Europe-Asia”, 620144 Yekaterinburg, Russia
| | | | - Jes Olesen
- Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, 1172 Copenhagen, Denmark
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Vinciguerra L, Cantone M, Lanza G, Bramanti A, Santalucia P, Puglisi V, Pennisi G, Bella R. Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review. J Pain Res 2019. [PMID: 31695483 DOI: 10.2147/jpr.s209485.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Migrainous infarction (MI) is a rare complication of migraines that accounts for 0.5-1.5% of all ischemic strokes. Although the pathogenesis of MI is still debated, cortical spreading depression and the consequent biochemical cascade and hemodynamic changes are presumed to play an important role. Here we describe a case of MI and systematically review the literature on the complex and possibly bidirectional relationship between migraine and stroke. A 44-year-old female with history of migraine with visual aura presented at the Emergency Department due to a sudden onset of left limb paresis and hypoesthesia. Brain magnetic resonance imaging revealed right fronto-parietal ischemic stroke. Two days after hospitalization, the patient experienced a prolonged visual aura and showed ultrasound evidence of intracranial artery vasospasm. To date, there have been 33 published articles on a total 119 patients with MI, although intracranial vasospasm has rarely been reported. Sustained hyperexcitability of cortical neurons, impairment of γ-aminobutyric acid inhibitory circuitry, altered serotonergic transmission, release of vasoconstrictive molecules, and cerebral blood flow changes have been proposed as pathogenic mechanisms of MI. The present case provides insight into the pathophysiological link between stroke and migraine, thus aiding clinicians in therapeutic decision-making although additional studies are needed to clarify the clinical, neuroradiological, and ultrasound findings that link MI and stroke-related migraine.
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Affiliation(s)
- Luisa Vinciguerra
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | | | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.,Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Alessia Bramanti
- Institute of Applied Sciences and Intelligent Systems (ISASI), IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Paola Santalucia
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Valentina Puglisi
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technology, Section of Neurosciences, University of Catania, Catania, Italy
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Cannella R, Sparacia G, Lo Re V, Oddo E, Mamone G, Miraglia R. Advanced magnetic resonance imaging of cortical laminar necrosis in patients with stroke. Neuroradiol J 2019; 32:431-437. [PMID: 31566507 DOI: 10.1177/1971400919876621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The aim of this study was to assess the novel advanced magnetic resonance imaging findings of acute stage cortical laminar necrosis developing after complicated cardiovascular or abdominal surgery. MATERIALS AND METHODS This institutional review board-approved study included patients with postoperative stroke due to cortical laminar necrosis imaged with magnetic resonance in the acute stage. Brain magnetic resonance imaging examinations were obtained on a 3T magnetic resonance scanner within 48 hours of the neurological symptoms, including diffusion-weighted images (b value, 1000 s/mm2) and arterial spin labelling using a pseudo-continuous arterial spin labelling method in four patients. Conventional and advanced magnetic resonance images were analysed to assess the imaging features in acute stage cortical laminar necrosis. RESULTS The final population consisted of 14 patients (seven men and seven women, mean age 61 years, range 32-79 years) diagnosed with stroke and acute phase cortical laminar necrosis. All the patients presented with cortical lesions showing restricted diffusion on diffusion-weighted images and hypointensity on the apparent diffusion coefficient map. Cortical hyperintensity on T2-weighted or fluid-attenuated inversion recovery images was found in three (21%) and six (43%) patients, respectively. Reduced perfusion was noted in three out of four patients imaged with arterial spin labelling, while in one case no corresponding perfusion abnormality was noted on the arterial spin labelling maps. Arterial spin labelling abnormalities were much more extensive than diffusion restriction in two patients, and they were associated with a poor outcome. CONCLUSION Cortical hyperintense abnormalities on diffusion-weighted imaging may be the only sign of developing cortical laminar necrosis injury. The acquisition of arterial spin labelling helps to identify perfusion alterations and the extension of the ischaemic injury.
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Affiliation(s)
- Roberto Cannella
- Radiology Service, Biomedicina, Neuroscienze e Diagnostica avanzata (BIND) Department, University of Palermo, Italy
| | - Gianvincenzo Sparacia
- Radiology Service, Biomedicina, Neuroscienze e Diagnostica avanzata (BIND) Department, University of Palermo, Italy.,Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Italy
| | - Vincenzina Lo Re
- Neurology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy
| | - Elisa Oddo
- Radiology Service, Biomedicina, Neuroscienze e Diagnostica avanzata (BIND) Department, University of Palermo, Italy
| | - Giuseppe Mamone
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Italy
| | - Roberto Miraglia
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Italy
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Sharma SR, Massaraf H, Das S, Kalita A. Cortical Laminar Necrosis as a Presenting Manifestation of Migraine in an Apparently Normal Patient: A Rare Case Report. J Neurosci Rural Pract 2019; 10:559-562. [PMID: 31616131 PMCID: PMC6788926 DOI: 10.1055/s-0039-1698009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
We present a 27-year-old female, a known case of classical migraine headache, who had a severe episode of migraine with visual aura attack which continued late into night. The next morning, she had persistent headache and developed abrupt onset of dysarthria and right hemiparesthesias. She attributed symptoms to her long-lasting headache problem and hence did not seek medical help for the next 2 weeks. The symptoms persisted despite her headache subsiding over the next 36 hours. Her condition worsened 2 weeks later during another such episode of headache. This time she developed right hemiparesis, right hemihypoesthesia, and brief and autolimited left-clonic facial movements. Extensive neurological workup done to rule out other known causes of cerebral infarct with cortical laminar necrosis (CLN) was unrevealing. Magnetic resonance imaging of the brain showed left frontoparietal T2-/T1-/fluid-attenuated inversion recovery hyperintensity without diffusion restriction in diffusion-weighted imaging and subtle blooming in gradient recalled-echo and was radiologically compatible with cortical laminar necrosis. The patient improved with antiplatelets, antimigraine prophylaxis, and stroke rehabilitation therapy. Our present case is a unique one where CLN can be associated with cerebral ischemic infarct due to migrainous etiology.
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Affiliation(s)
- Shri Ram Sharma
- Department of Neurology, North Eastern Indira Gandhi Regional Institute of Health and Medical Science, Shillong, Meghalaya, India
| | - Hussain Massaraf
- Department of Neurology, North Eastern Indira Gandhi Regional Institute of Health and Medical Science, Shillong, Meghalaya, India
| | - Sumit Das
- Department of Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Science, Shillong, Meghalaya, India
| | - Arnab Kalita
- Department of Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Science, Shillong, Meghalaya, India
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Vinciguerra L, Cantone M, Lanza G, Bramanti A, Santalucia P, Puglisi V, Pennisi G, Bella R. Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review. J Pain Res 2019; 12:2941-2950. [PMID: 31695483 PMCID: PMC6814312 DOI: 10.2147/jpr.s209485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 02/05/2023] Open
Abstract
Migrainous infarction (MI) is a rare complication of migraines that accounts for 0.5-1.5% of all ischemic strokes. Although the pathogenesis of MI is still debated, cortical spreading depression and the consequent biochemical cascade and hemodynamic changes are presumed to play an important role. Here we describe a case of MI and systematically review the literature on the complex and possibly bidirectional relationship between migraine and stroke. A 44-year-old female with history of migraine with visual aura presented at the Emergency Department due to a sudden onset of left limb paresis and hypoesthesia. Brain magnetic resonance imaging revealed right fronto-parietal ischemic stroke. Two days after hospitalization, the patient experienced a prolonged visual aura and showed ultrasound evidence of intracranial artery vasospasm. To date, there have been 33 published articles on a total 119 patients with MI, although intracranial vasospasm has rarely been reported. Sustained hyperexcitability of cortical neurons, impairment of γ-aminobutyric acid inhibitory circuitry, altered serotonergic transmission, release of vasoconstrictive molecules, and cerebral blood flow changes have been proposed as pathogenic mechanisms of MI. The present case provides insight into the pathophysiological link between stroke and migraine, thus aiding clinicians in therapeutic decision-making although additional studies are needed to clarify the clinical, neuroradiological, and ultrasound findings that link MI and stroke-related migraine.
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Affiliation(s)
- Luisa Vinciguerra
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
- Correspondence: Luisa Vinciguerra Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124Messina, ItalyTel +39 090 6012 8395Fax +39 090 6012 8850 Email
| | | | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Department of Neurology IC, Oasi Research Institute – IRCCS, Troina, Italy
| | - Alessia Bramanti
- Institute of Applied Sciences and Intelligent Systems (ISASI), IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Paola Santalucia
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Valentina Puglisi
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technology, Section of Neurosciences, University of Catania, Catania, Italy
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Long-Term Follow-Up in Children With Focal Cortical Dysplasia IIId for Early Brain Injuries, Including Neuropathological Findings. Pediatr Neurol 2018; 88:40-47. [PMID: 30473064 DOI: 10.1016/j.pediatrneurol.2018.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/15/2018] [Accepted: 08/28/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Early cerebral injury has a close relationship with epilepsy and focal cortical dysplasia Ⅲd. We investigated children with focal cortical dysplasia Ⅲd who underwent surgery for epilepsy. METHODS We selected 49 patients from among 260 pediatric patients who had undergone epilepsy surgery, analyzing their clinical materials and pathology data. The selected patients had been followed for more than two years. RESULTS The 49 patients were divided into seven groups based on different early brain injuries. There was a significant difference (P < 0.05) between Engel class I ratio of cerebral hemorrhage group (84.6%) and that of central nervous system infection group (42.1%) in two to eight years follow-up. The patients with prior cerebral hemorrhage had a wider scope (P < 0.05) of brain damage than those in the brain infection and febrile convulsion groups. Secondary polymicrogyria commonly existed. Neuron islands were located adjacent to polymicrogyria in cerebral hemorrhage and brain trauma patients, and missing neuronal laminations beside the polymicrogyria was noted in others. CONCLUSIONS In children with focal cortical dysplasia Ⅲd, individuals with cerebral hemorrhage within the perinatal period exhibited a wider range of brain lesions, while the postoperative follow-up outcome was better. Secondary polymicrogyria existed along with focal cortical dysplasia Ⅲd and is related to the developmental lesion. The processes of secondary polymicrogyria caused by different early brain injuries might be different.
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Khardenavis V, Karthik DK, Kulkarni S, Deshpande A. Cortical laminar necrosis in a case of migrainous cerebral infarction. BMJ Case Rep 2018; 2018:bcr-2017-221483. [PMID: 29592973 DOI: 10.1136/bcr-2017-221483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We report a 27-year-old woman, a known case of classical migraine headache, on oral contraceptive pills. She had a severe episode of migraine with visual aura attack, which continued late into the night. The next early morning, her headache persisted and she developed abrupt onset of dysarthria, right hemiparaesthesias. She attributed symptoms to her long-standing headache problem, and hence did not seek medical help for the next two weeks. The symptoms persisted despite her headache subsiding over the next 24 hours. She worsened 2 weeks later during another such episode of headache. This time, she developed right hemiparesis. The patient was admitted with provisional diagnosis of stroke. MRI of the brain showed left temporoparietal lesion and was radiologically compatible with cortical laminar necrosis.Extensive work-up was done to rule out other causes of young stroke. The patient improved with antiplatelets, antimigraine prophylaxis and stroke rehabilitation therapy.
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Affiliation(s)
| | | | - Sharvari Kulkarni
- Maharashtra Institute of Medical Education and Research, Pune, Maharashtra, India
| | - Anirudda Deshpande
- Department of Neurology, Vinayaka Neuro Multispecialty Clinic, Warangal, Telangana, India
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Morais R, Sobral F, Cunha G, Brito O, Santana I. Advanced MRI study of migrainous infarction presenting as cortical laminar necrosis - Case report and literature review. Clin Neurol Neurosurg 2018; 167:82-85. [PMID: 29471286 DOI: 10.1016/j.clineuro.2018.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/14/2017] [Accepted: 02/09/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Ricardo Morais
- Coimbra Hospital and University Centre - Medical Imaging Department, Portugal.
| | - Filipe Sobral
- Coimbra Hospital and University Centre - Neurology Department, Portugal
| | - Gil Cunha
- Coimbra Hospital and University Centre - Medical Imaging Department, Portugal
| | - Olga Brito
- Coimbra Hospital and University Centre - Medical Imaging Department, Portugal
| | - Isabel Santana
- Coimbra Hospital and University Centre - Neurology Department, Portugal
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Wang DD, Piao YS, Blumcke I, Coras R, Zhou WJ, Gui QP, Liu CC, Hu JX, Cao LZ, Zhang GJ, Lu DH. A distinct clinicopathological variant of focal cortical dysplasia IIId characterized by loss of layer 4 in the occipital lobe in 12 children with remote hypoxic-ischemic injury. Epilepsia 2017; 58:1697-1705. [PMID: 28833053 DOI: 10.1111/epi.13855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In 2011, the International League Against Epilepsy (ILAE) proposed a consensus classification system of focal cortical dysplasia (FCD) to distinguish clinicopathological subtypes, for example, "isolated" FCD type Ia-c and IIa-b, versus "associated" FCD type IIIa-d. The histopathological differentiation of FCD type I and III variants remains, however, a challenging issue in everyday practice. We present a unique histopathological pattern in patients with difficult-to-diagnose FCD, which highlights this dilemma, but also helps to refine the current ILAE classification scheme of FCD. METHODS We present a retrospective series of 11 male and one female patient with early onset pharmacoresistant epilepsy of the posterior quadrant (mean age at seizure onset = 4.6 years). All surgical specimens were reviewed. Clinical histories were retrieved and extracted from archival patient files. RESULTS Microscopic inspection revealed abnormalities in cortical architecture with complete loss of layer 4 in all surgical samples of the occipital lobe, as confirmed by semiquantitative measurements (p < 0.01). Clinical history reported early transient hypoxic condition in nine patients (75%). Magnetic resonance imaging (MRI) revealed abnormal signals in the occipital lobe in all patients, and signal changes suggestive of subcortical encephalomalacia were found in seven patients. Surgical treatment achieved favorable seizure control (Engel class I and II) in seven patients with an available follow-up period of 6.1 years. SIGNIFICANCE Prominent disorganization of cortical layering and lack of any other microscopically visible principle lesion in the surgical specimen would result in this neuropathological pattern hitherto being classified as FCD ILAE type Ib. However, perinatal hypoxia with distinctive MRI changes suggested primarily a hypoxemic lesion and acquired pathomechanism of neuronal cell loss in the occipital lobe of our patient series. We propose, therefore, classifying this distinctive clinicopathological pattern as a separate variant of FCD ILAE type IIId.
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Affiliation(s)
- Dan-Dan Wang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yue-Shan Piao
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ingmar Blumcke
- Neuropathological Institute, University Hospitals Erlangen, Erlangen, Germany
| | - Roland Coras
- Neuropathological Institute, University Hospitals Erlangen, Erlangen, Germany
| | - Wen-Jing Zhou
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing, China
| | - Qiu-Ping Gui
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Cui-Cui Liu
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing-Xia Hu
- Department of Pathology, Tsinghua University Yuquan Hospital, Beijing, China
| | - Li-Zhen Cao
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guo-Jun Zhang
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - De-Hong Lu
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
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