14. MR imaging detection of cerebral microbleeds: effect of susceptibility-weighted imaging, section thickness, and field strength. Cortical superficial siderosis: detection and - Oxford Academic The avidin-biotin horseradish peroxidase (ABC-HRP) complex method was used (Vectastain Elite kit, Vector Laboratories, Peterborough, UK), with diaminobenzidine (DAB) as the substrate. ADVERTISEMENT: Supporters see fewer/no ads. (d) Perivascular stainable-iron deposition was confirmed using Perl's staining. Why not brain injury? 1. Haemosiderin deposition and vascular pathology in the putamen were quantified in 200 brains donated to the population-representative Medical Research Council Cognitive Function and Ageing Study. Hemosiderin staining usually happens on the lower leg, near the ankles, or on your feet. Several MRI studies have investigated the prevalence of microbleeds in the ageing population, and report CMB frequencies ranging from 3% to 38% 4,2629. The incidences of hemosiderin-positive regions in subarachnoid space on T2*-weighted MRI were 76.0% (19/25 patients), 66.7% (8/12), and 76.2% (16/21) at 3 to 4, 4 to 12, and 12 to 18 months after SAH . We suggest that there is no pathogenetic or qualitative difference between histological focal haemosiderin and MRI CMB, simply a matter of a size threshold. Idiopathic superficial siderosis of the central nervous system It's caused by blood leaking out of the tiny vessels called capillaries. MRI Cerebral microhemorrhages are only seen on MRI and are only seen on susceptibility weighted T2* sequences such as gradient-recalled echo (GRE) and susceptibility weighted imaging (SWI) 24. (2018) Journal of medical imaging and radiation oncology. Invest Radiol. Later, when still fresh, it will likely show up on a conventional MRI. Bethesda, MD 20894, Web Policies The ultimate answer as to why these more tailored protocols arent done is that no one is demanding it. Careers, Unable to load your collection due to an error. An official website of the United States government. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-9486, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":9486,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/superficial-siderosis-1/questions/1023?lang=us"}. Neuropathology and Applied Neurobiology published by John Wiley & Sons Ltd on behalf of British Neuropathological Society. Jeerakathil T, Wolf PA, Beiser A, Hald JK, Au R, Kase CS, Massaro JM, DeCarli C. Cerebral microbleeds: prevalence and associations with cardiovascular risk factors in the Framingham Study. The prevalence increases in normal ageing where the majority of CMB occur in deep brain structures, including the putamen 3,4, and in patients with hypertension, cerebral ischaemia, intracerebral haemorrhage and stroke 5. Tumors are thought to be more dangerous thanhemosiderin. Superficial siderosis following spontaneous intracranial hypotension. A novel MHC class I-like gene is mutated in patients with hereditary haemochromatosis. 26. Cerebral microbleeds: a guide to detection and interpretation. As there are many causes of recurrent or extensive subarachnoid hemorrhage, the demographics are ill-defined and represent those of the underlying cause. Amyloid-related imaging abnormalities-haemosiderin (ARIA-H) in - PubMed In essence, this improvement allows us to see pathology that might exist between the layers of the 2mm slices. Comparison with whole brain assessment of presence of lacunes showed a positive association with severity of haemosiderin deposits (P=0.023). 7. Emerging experience of imaging at higher field strengths suggest a predictable increase in rate of detection, and the apparent size of CMB detected 31. Magnetic resonance imaging (MRI) cerebral microbleeds (CMB) arise from ferromagnetic haemosiderin iron assumed to derive from extravasation of erythrocytes. Stroke. 2010;20(2):134-40. A cause of recurrent subarachnoid hemorrhage is present in ~50% of cases 1-6,8: Usually unrewarding; will not demonstrate a point of bleeding 1. 4. This process was repeated five times and the mean of these counts calculated and multiplied by 0.04 to give the cross-sectional area in cm2. Sveinbjornsdottir S, Sigurdsson S, Aspelund T, Kjartansson O, Eiriksdottir G, Valtysdottir B, Lopez OL, van Buchem MA, Jonsson PV, Gudnason V, Launer LJ. Hemosiderotic synovitis: Highlighting the role of T2 weighted sequence Nandigam RN, Viswanathan A, Delgado P, Skehan ME, Smith EE, Rosand J, Greenberg SM, Dickerson BC. 2010;31(1):5-14. Brain iron homeostasis. The site is secure. Grouped clusters of several profiles ( a ;, ( a ) Perspex chamber loaded with formalin fixed frontal lobe brain slices. Light microscopy of ageing brain frequently reveals foci of haemosiderin from single crystalloids to larger, predominantly perivascular, aggregates. Complications are increased intracerebral pressure as a result of the hemorrhage itself, surrounding edema or hydrocephalus due to obstruction of CSF. Sections were microwaved in trisodium citrate solution (pH6.5) for antigen retrieval and blocked with 1.5% normal sera for 30min before incubation with the primary antibody for 1h at room temperature [glial fibrillary acidic protein: GFAP (1:500, Dako, Ely, UK); CD68 (1:100, Dako); CD163 (1:100, Serotec, Kidlington, UK); fibrinogen (1:400, Alere Ltd, Stockport, UK); ferritin (1:1000, Sigma, Poole, UK)]. Brain. Sadly, this discussion of the state of the art of neuroimaging may not be outdated even a decade from now. The incidence of dementia in England and Wales: findings from the five identical sites of the MRC CFA Study. Today, the Susceptibility Weighted Imaging or SWI, offers the best images of hemosiderin. (2010) ISBN:1931884781. Of interest the chief neuropsychological correlates associated with CMB are precisely those now invoked as the core features of subcortical ischaemic encephalopathy related to small vessel ischaemia 33,49,50. 2016;87(17):1777-86. Other pathological data on the donors were obtained from the archives of the MRC CFAS (http://www.cfas.ac.uk). Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. A significantly higher number of haemosiderin deposits were detected in periarterial/periarteriolar regions (mean 7.680.952) compared with parenchymal (pericapillary) locations (2.790.55) (P<0.001) (Figure2b). Susceptibility-weighted imaging of cerebral fat embolism. Wouldnt those particularly vulnerable undersides of the frontal lobes and get a closer look? An important consideration is the nature and origin of haemosiderin. The MRI method was optimized to ensure that the signal voids demonstrated most likely correspond to CMB as described in clinical imaging of living patients 2. CFAS is a longitudinal, prospective population-representative study in which brain donor recruitment was solely based on age (over 65 years) 18 and was unrelated to dementia or other clinical data. Pesaresi I, Sabato M, Desideri I, Puglioli M, Moretti P, Cosottini M. 3.0T MR Investigation of CLIPPERS: Role of Susceptibility Weighted and Perfusion Weighted Imaging. Hanson EH, Imperatore G, Burke W. HFE gene and hereditary hemochromatosis: a HuGE review. PMC Kammeyer R, Schreiner T. Cortical Vein Thrombosis, Tortuous Venous Vasculature, and Microhemorrhages in Neurosarcoidosis. Brain. A tailored MRI protocol costs more. 13. Human Genome Epidemiology. Focal haemosiderin deposition will be more prominent in people whose brain is predisposed to increased iron uptake for example associated with pathogenic. Hemosiderin, in contrast to ferritin, is an amorphous iron-containing substance with no fixed composition. 2019;1205:25-53. doi: 10.1007/978-3-030-31904-5_3. Salvador GA, Uranga RM, Giusto NM. 4. The pathological and radiological relationship between these findings is not resolved. MRI (Philips, Eindhoven, the Netherlands) was performed at 3.0Tesla using a susceptibility-weighted protocol optimized for post mortem brain imaging. Although it is common to see a small amount of hemosiderin deposition at the margins of a previous hemorrhage or surgical resection margin, a single episode of subarachnoid hemorrhage is usually not sufficient to result in this condition 2. Connor JR, Lee SY. FOIA He has spoken at numerous brain injury seminars and is the author of the most read brain injury web pages on the internet, including http://waiting.com and http://tbilaw.com When Attorney Johnson talks about "recovery", he isn't talking about what a survivor recovers in litigation, but about getting better from a brain injury. COVID-19 associated Diffuse Leukoencephalopathy and Microhemorrhages. The Radiology Assistant : Non-traumatic Intracranial Hemorrhage A decade ago, the favored protocol was called a Gradient Echo Imaging, or GRE. Pneumocephalus mimicking cerebral cavernous malformations in MR susceptibility-weighted imaging. Lancet Neurol. Hemosiderin rim The hypointensity can be delineated further in the gradient echo sequence T2* images due to hemosiderin deposition in and around the cavernous malformation 1) 2). AJNR Am J Neuroradiol. 2023 ICD-10-CM Diagnosis Code R90.89 - ICD10Data.com Magnetic resonance imaging (MRI) cerebral microbleeds (CMB) arise from ferromagnetic haemosiderin iron assumed to derive from extravasation of erythrocytes. -, Greenberg SM, Vernooij MW, Cordonnier C, Viswanathan A, Al-Shahi Salman R, Warach S, Launer LJ, Van Buchem MA, Breteler MM. and transmitted securely. At the time the article was last revised Rohit Sharma had Formalin fixed frontal lobe brain tissue coronal slices underwent MRI analysis at 3.0T in a custom built Perspex chamber (Figure2a), and showed profiles corresponding to typical microbleed signal voids (Figure2b). T2*-weighted MRI showed that the hemosiderin was deposited preferentially in the cortical sulcus and sylvian fissure but also in small foci in the ventricular (6.9%) and cisternal systems (1.7%). Cerebral air emboli on T2-weighted gradient-echo magnetic resonance imaging. The donated brains were pathologically assessed by neuropathologists following the Consortium to Establish a Registry of Alzheimer's Disease (CERAD) protocol 19 and Braak staging 20 in addition to assessments of vascular pathology, including arteriosclerosis, atheroma, SVD, microinfarction, lacunes and parenchymal integrity. Bookshelf CMB were defined as foci of blooming artefact up to 5mm in diameter that may represent microhaemorrhages taking care to count away from sulci to avoid air/fluid interface artefact. Superficial siderosisis a rare condition which results from the deposition of hemosiderin along the leptomeninges, with eventual neurological dysfunction. Magnetic resonance imaging (MRI) cerebral microbleeds (CMB) arise from ferromagnetic haemosiderin iron assumed to derive from extravasation of erythrocytes. Sperling R, Jack C, Black S et al. This difference may reflect the large sample size, and population-based sampling, of the CFAS cohort investigated in this study, compared with the previous report (33 cases) 3. What is hemosiderin staining in the brain - Susceptibility-weighted MRI in the axial plane showed extensive hemosiderin deposition on the facies cerebralis (solid arrows), consistent with superficial hemosiderosis, numerous microhaemorrhages in the brain parenchyma (dotted arrow), most of these subcortically in the left hemisphere . 20. haemorrhage; haemosiderin; ischaemia; microbleeds; small vessel disease; stroke. Nozaki H, Sekine Y, Fukutake T et al. 8600 Rockville Pike Cerebral Microhemorrhage | Stroke For conventional gradient echo T2 weighted sequences the parameters were: repetition time of 500ms; echo time 16ms; flip angle 16; voxel size 0.450.442.0mm (slice thickness 2mm); number of excitations 3. Diffusion Weighted Imaging in Hemorrhage | Radiology Key Someday 1024 x 768 resolution will be the norm, at least in the areas most likely susceptible to mild brain injury pathology. JAMA Neurol. Poels MM, Vernooij MW, Ikram MA, Hofman A, Krestin GP, van der Lugt A, Breteler MM. What Is Hemosiderin Staining In The Brain - researchtopics.quest De Sciscio M, De Sciscio P, Vallat W, Kleinig T. Cerebral Microbleed Distribution Following Cardiac Surgery Can Mimic Cerebral Amyloid Angiopathy. Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. Wharton S, Brayne C, Savva G, Matthews F, Forster G, Simpson J, Lace G, Ince P. Epidemiological neuropathology: The MRC Cognitive Function and Ageing Study experience. Pathology of the Vestibulocochlear Nerve. Khan N, Saherwala A, Chen M et al. Brain haemosiderin in older people: pathological evidence for an IQR, interquartile range; CAA, cerebral amyloid angiopathy; FPVA, focal perivascular attenuation. 2015;15 (5): 382-4. Cerebral microbleeds in CADASIL: a gradient-echo magnetic resonance imaging and autopsy study. The use of an immersion oil was found to minimize artefacts associated with air and water interfaces and edge artefacts. ferritin and hemosiderin MRI - Questions and Answers in MRI Bilgic B, Pfefferbaum A, Rohlfing T, Sullivan EV, Adalsteinsson E. MRI estimates of brain iron concentration in normal aging using quantitative susceptibility mapping. With all tailored protocols, there is always a cost benefit analysis. Case Report: Diffuse Cerebral Microbleeds in Cerebral Autosomal Recessive Arteriopathy With Subcortical Infarcts and Leukoencephalopathy. A more definitive test of our hypothesis, given the modest power to test it using these genetic data, would be to make direct measurements of brain iron content for comparison with data on CMB and microscopical focal haemosiderin deposits. When blood leaves a ruptured blood . Frequency and appearance of hemosiderin depositions after - PubMed Bugiani M, Kevelam S, Bakels H et al. Harnsberger HR, Glastonbury CM, Michel MA et-al. CFAS collects information from study respondents and informants including the presence of dementia, stroke, diabetes and heart disease 23. Taken with the association of CMB with cerebral infarction, such findings raise the possibility that haemosiderin deposition in the ageing brain may accumulate from sources other than extravasated erythrocytes. Greenberg SM, Vernooij MW, Cordonnier C, Viswanathan A, Al-Shahi Salman R, Warach S, Launer LJ, Van Buchem MA, Breteler MM. Fazekas F, Kleinert R, Roob G, Kleinert G, Kapeller P, Schmidt R, Hartung HP. The number of points falling over the putamen was counted. Part II. However CMB are also well described in the context of CADASIL, a brain disorder in which characteristic vascular sclerosis is not associated with pathological evidence of acute microhaemorrhage and in which clinical intracerebral haemorrhage is very rare 10,11. A brain bleed does the same thing to brain tissue. Think of getting a glob of ketchup on a white shirt. Other areas where tailored protocols may come into play is increasing the proximity of the MRI slices thru the brain from the standard 2 mm slices to one mm. The apoprotein units that comprise the shell are composed of a mixture of ferritin light and ferritin heavy derived from two different genes. In circumstances other than CAA it has been suggested that age-related changes in the structure of the bloodbrain barrier may result in opening of endothelial junctions thereby allowing egress of red blood cells, resulting in CMB 3,8,9. The .gov means its official. 19. no financial relationships to ineligible companies to disclose. Rather it is formed within secondary lysosomes as a complex of ferritin, iron and proteins (including membrane proteins) produced in any circumstances of iron overload of macrophages and other cell types 15. Merritt's Neurology. Neuropathologists have been familiar with hemosiderin, because they can see the hemosiderin stain on autopsy. Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. CD68+ microglia were predominantly of a highly branched morphology and were evenly distributed throughout the putamen and did not appear associated with haemosiderin deposition (P=0.69). CAA is associated with a high frequency of cortical MRI CMB 1. In the present study we have sought evidence to support an alternative hypothesis for the origin of haemosiderin foci (and by implication the source of MRI CMB) based on increasing saturation of iron storage in older brains as a consequence of unidirectional iron uptake. Cerebral microhemorrhages are only seen on MRI and are only seen on susceptibility weighted T2* sequences such as gradient-recalled echo (GRE)and susceptibility weighted imaging (SWI)24. Typical symptoms include 2-5: It is important to realize that the degree of imaging abnormality does not always correlate with the degree of clinical impairment 4. Excessive amounts of splenic hemosiderin are seen when erythropoiesis is . There were significant associations with indices of local vascular pathology, including both pathology of small vessels and ischaemic parenchymal lesions, in the putamen. Standardization of the neuropathologic assessment of Alzheimer's disease. Swartz J. 3. 9. 6. Five random regions within the area of interest were selected (20 magnification; CellR, Olympus, Southend-on-Sea, UK), and the percentage area immunoreactivity of the image analysed using analysisD software (Olympus Biosystems, Planegg, Germany) following delineation and exclusion of vascular profiles and voids in the sections. The materials on this web page are provided purely for informational purposes. Differentiation Between Calcification and Hemorrhage in Brain Tumors The Whole Picture: From Isolated to Global MRI Measures of Neurovascular and Neurodegenerative Disease. Dysregulation of iron homeostasis can result in increased oxidative stress and ultimately neurodegeneration 40, therefore iron content in the CNS is strictly regulated by a number of proteins, including HFE 41. It does not represent a specific molecular intermediate of haemoglobin degradation. Cerebral microhemorrhage | Radiology Reference Article | Radiopaedia.org Foci of haemosiderin were identified in both periarterial (and arteriolar) and pericapillary locations (b; arrows). Journal of neurology, neurosurgery, and psychiatry. Molecular markers of gliosis and tissue integrity were assessed by immunohistochemistry in brains with highest (n=20) and lowest (n=20) levels of putamen haemosiderin. You quickly wipe it off, stop the spreading. Time in a scanner can be unpleasant and exceedingly boring. Faster scanning times are eliminating some of that disadvantage. Other aspects of brain hemorrhage are discussed elsewhere. The histopathology of CAA is frequently associated with evidence of microhaemorrhages and the clinical manifestations include lobar haemorrhages 7. ADVERTISING MATERIALBrought to you by The Brain Injury Law Group, SC. Epub 2016 Sep 19. In contrast to this idea of an origin from extravasation we propose that focal haemosiderin deposits may arise from local iron sources within the brain. Superficial siderosis. While this page is not intended to be a source of advertising, solicitation or legal advice, it could be deemed to be such.Click here for our full disclaimer. The https:// ensures that you are connecting to the Hemosiderin often forms after bleeding (haemorrhage). Imaging the Patient with Epilepsy - Diseases of the Brain, Head and These markers included the presence of: atheroma of larger perforating arteries; significant arterial and arteriolar sclerosis; microinfarcts; perivascular (Figure1c) or more widespread attenuation and rarefaction of the parenchyma (often associated with neuronal loss and astrogliosis), arteriolar microaneurysm formation. 8. Hemosiderin Staining: Causes, Symptoms, and Treatment - Healthline We propose that accumulation of focal haemosiderin deposits in older peoples brains in part reflects the inability of the ageing brain to store ferritin iron released from ischemic damage to oligodendrocytes and other cells because of a reduced overall population of remaining healthy brain cells. Braak H, Alafuzoff I, Arzberger T, Kretzschmar H, Del Tredici K. Staging of Alzheimer disease-associated neurofibrillary pathology using paraffin sections and immunocytochemistry. Abnormal brain ultrasound Abnormal ultrasound of brain Imaging of central nervous system abnormal Magnetic resonance imaging of brain abnormal ICD-10-CM R90.89 is grouped within Diagnostic Related Group (s) (MS-DRG v40.0): 947 Signs and symptoms with mcc 948 Signs and symptoms without mcc Convert R90.89 to ICD-9-CM Code History Our data, in contrast, are consistent with the hypothesis that white matter and basal ganglia focal haemosiderin/CMB deposits are frequently ischaemic in origin and have different biomarker implications. Detection of Hemosiderin Deposition by T2*-Weighted MRI After - Stroke For the purposes of this report the term CMB will be exclusively used in the context of the MR paramagnetic artefact. Tel: +441142222261; Fax: +441142222290; E-mail: Received 2013 Jan 21; Accepted 2013 May 16. But when the significant mass of the blood has been reabsorbed, all that will be left is the stain. Mirra SS, Heyman A, McKeel D, Sumi SM, Crain BJ, Brownlee LM, Vogel FS, Hughes JP, van Belle G, Berg L. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). The area of the putamen in each section was measured using a point-counting approach: A clear acetate marked with points in a 2-mm grid pattern was placed over the microscope slide with random orientation and position. HFE mutations and Alzheimer's disease. 1995;118 ( Pt 4)(4):1051-66. The MRI appearance of cSS results from paramagnetic blood breakdown residues (including haemosiderin, a stable end-product of blood breakdown), which cause local magnetic field inhomogeneity resulting in signal loss on T 2 *-GRE and susceptibility-weighted imaging (SWI) sequences ( Atlas et al., 1988; Greenberg et al., 1996; Haacke et al., 2004) Shouldnt such higher processing power be directed at the frontal lobes? (a) Perspex chamber loaded with formalin fixed frontal lobe brain slices used to present tissue for magnetic resonance imaging (MRI). Deparaffinized 6-m sections of the putamen were incubated with 3% H2O2 in methanol for 20min to block endogenous peroxidase activity. Fanout EM, Coutinho JM, Shannon P, et al. Neuroimaging Clin N Am. Susceptibility-weighted MRI in the axial plane showed extensive hemosiderin deposition on the facies cerebralis (solid arrows), consistent with superficial hemosiderosis, numerous microhaemorrhages in the brain parenchyma (dotted arrow), most of these . Dichgans M, Holtmannspotter M, Herzog J, Peters N, Bergmann M, Yousry TA. J. Neurosurg. (a,b,c haematoxylin and eosin; d Perl's stain: a,c 40 obj; b 10 obj; d 20 obj.). Journal of Neurology, Neurosurgery & Psychiatry. The term ferritin refers to fully assembled iron-containing shells. government site. Matthews FE, Brayne C, Lowe J, McKeith I, Wharton SB, Ince P. Epidemiological pathology of dementia: attributable-risks at death in the Medical Research Council Cognitive Function and Ageing Study. 8600 Rockville Pike You wash the shirt, the ketchup is all gone, but a stain remains. Conclusions: J Comput Assist Tomogr. Wen L, Yuan J, Li S et al. An evaluation of skin in the leg related to chronic venous stasis for example found perivascular haemosiderin to be infrequent and usually associated with local inflammation 37. Before 4 Microhemorrhages appear larger on GE sequences compared with the actual tissue lesions because of the so-called "blooming effect" of the MR signal at the border of these lesions. AJNR Am J Neuroradiol. Cases have been reported in patients between 14 and 77 years of age 5. In contrast the histological appearances are described as focal haemosiderin throughout. 5. In total, 185 T2*-weighted MRI studies obtained between 2 days and 148 months after SAH were evaluated (mean follow-up 30.2 months). 23 (1): 75-8. -. Prevalence and risk factors of cerebral microbleeds: an update of the Rotterdam scan study. In: Werring D, editor. Sharma R, Dearaugo S, Infeld B, O'Sullivan R, Gerraty RP. Fisher M, French S, Ji P, Kim RC. Nandar W, Connor JR. HFE gene variants affect iron in the brain. Cerebral microbleeds are small MRI signal voids indicative of focal haemosiderin deposition. Association between putaminal haemosiderin deposition, brain pathology scores, local vascular pathology measures and cerebrovascular risk factor clinical data. Any type of bleeding inside the skull or brain is a medical emergency. Microbleeds in Moyamoya Disease: Susceptibility-Weighted Imaging Versus T2*-Weighted Imaging at 3 Tesla. Neuropathologic correlates of white matter hyperintensities. haemorrhage, haemosiderin, ischaemia, microbleeds, small vessel disease, stroke. Hemosiderin is a stain, left behind after a brain bleed, even after though the blood is reabsorbed into the blood system. 01;69 (9): 1206-7. HHS Vulnerability Disclosure, Help Careers. The failure to ask for a higher resolution images if partially because of priorities. The parameters for the susceptibility weighted sequence were: repetition time 29ms; echo time 15ms; flip angle 15; voxel size 0.450.451mm (slice thickness 1mm); number of excitations 2; acceleration factor 1.2. Comparison of area of MRI CMB in frontal lobe tissue slices in brains characterized by high (6) and low (6) focal haemosiderin counts in the putamen, It is widely assumed that MRI CMB reflect extravasation of red blood cells from cerebral blood vessels, resulting in pericyte erythrophagocytosis, haemoglobin degradation and haemosiderin deposition 13,5. An official website of the United States government. Federal government websites often end in .gov or .mil. Comparison of the frequency of CMB profiles in six cases selected with high frequency of putamen focal haemosiderin deposition and six cases selected with low deposition showed that more microbleeds (predominantly in a frontal white matter distribution) is shown in Table2. Hachinski V, Iadecola C, Petersen R, Breteler M, Nyenhuis D, Black S, Powers W, DeCarli C, Merino J, Kalaria R, Vinters H, Holtzman D, Rosenberg G, Wallin A, Dichgans M, Marler J, LeBlanc G. National Institute of Neurological Disorders and Canadian-Stroke Network Vascular Cognitive Impairment harmonisation standards. The .gov means its official.
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