Letters to the editor
Obsessive-compulsive symptoms associated with left temporal dysembryoplastic neuroepithelial tumor: A case report
Ritwik Ghosha, Abhiram Narasimhan Purohithb,
, G. Lakshmi Prasadc, Rashmi Appajib, Sonia Shenoyb
Corresponding author
a Children First Mental Health Services, New Delhi, India
b Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India– 576104
c Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India– 576104
Read
410
Timeswas read the article
56
Total PDF
354
Total HTML
Share statistics
array:22 [ "pii" => "S0213616322000763" "issn" => "02136163" "doi" => "10.1016/j.ejpsy.2022.09.001" "estado" => "S300" "fechaPublicacion" => "2023-01-01" "aid" => "199" "copyright" => "Asociación Universitaria de Zaragoza para el Progreso de la Psiquiatría y la Salud Mental" "copyrightAnyo" => "2022" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Eur J Psychiatry. 2023;37:69-70" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:18 [ "pii" => "S021361632200060X" "issn" => "02136163" "doi" => "10.1016/j.ejpsy.2022.08.002" "estado" => "S300" "fechaPublicacion" => "2023-01-01" "aid" => "196" "copyright" => "Asociación Universitaria de Zaragoza para el Progreso de la Psiquiatría y la Salud Mental" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Eur J Psychiatry. 2023;37:67-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letters to the editor</span>" "titulo" => "Serum brain-derived neurotrophic factor levels in depression with and without melancholy and in healthy participants" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "67" "paginaFinal" => "68" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Reiji Yoshimura, Naomichi Okamoto, Atsuko Ikenouchi" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Reiji" "apellidos" => "Yoshimura" ] 1 => array:2 [ "nombre" => "Naomichi" "apellidos" => "Okamoto" ] 2 => array:2 [ "nombre" => "Atsuko" "apellidos" => "Ikenouchi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021361632200060X?idApp=UINPBA00004N" "url" => "/02136163/0000003700000001/v1_202301030654/S021361632200060X/v1_202301030654/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letters to the editor</span>" "titulo" => "Obsessive-compulsive symptoms associated with left temporal dysembryoplastic neuroepithelial tumor: A case report" "tieneTextoCompleto" => true "saludo" => "Dear editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "69" "paginaFinal" => "70" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ritwik Ghosh, Abhiram Narasimhan Purohith, G. Lakshmi Prasad, Rashmi Appaji, Sonia Shenoy" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Ritwik" "apellidos" => "Ghosh" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 1 => array:4 [ "nombre" => "Abhiram Narasimhan" "apellidos" => "Purohith" "email" => array:1 [ 0 => "abhiram.pn@manipal.edu" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0001" ] ] ] 2 => array:3 [ "nombre" => "G. Lakshmi" "apellidos" => "Prasad" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0003" ] ] ] 3 => array:3 [ "nombre" => "Rashmi" "apellidos" => "Appaji" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] ] ] 4 => array:3 [ "nombre" => "Sonia" "apellidos" => "Shenoy" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Children First Mental Health Services, New Delhi, India" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India– 576104" "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India– 576104" "etiqueta" => "c" "identificador" => "aff0003" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1129 "Ancho" => 3000 "Tamanyo" => 270954 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Axial MR images showing a well-defined intra-axial lesion with a bubbly appearance in the left hippocampus, which is heterogeneously hypointense on T1 (A), heterogeneously hyperintense on T2 (B) and FLAIR images (C).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0002" class="elsevierStylePara elsevierViewall">Obsessive-compulsive disorder (OCD) is a chronic psychiatric illness with a lifetime prevalence of 1–3%.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> A complex interaction between genetic and environmental factors has been implicated in the etiopathogenesis of OCD.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> Obsessive-compulsive symptoms can also be associated with various neurological illnesses, including mass lesions or infarcts, particularly in the striatum, frontal or temporal lobes, infection, closed head injury or neurodegenerative disorders.<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a></p><p id="para0003" class="elsevierStylePara elsevierViewall">Dysembryoplastic neuroepithelial tumours (DNET) are uncommon, benign, mixed neuronal-glial tumours which usually present with seizures, headache or focal neurological deficits.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> We report a rare clinical association of DNET with obsessive-compulsive symptoms in a 37-year-old lady, which improved after surgical resection.</p><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Case report</span><p id="para0004" class="elsevierStylePara elsevierViewall">Mrs A, a 37-year-old married lady, presented to the psychiatry outpatient department with two months history of repetitive, intrusive blasphemous thoughts, pathological doubts, and intrusive mental images of wild animals and snakes, which used to cause her a lot of distress. It was associated with compulsive checking, reassurance seeking and cognitive compulsions by substituting distressing images. Since early childhood, she had high myopia and was diagnosed with hypothyroidism two years prior. Family history is significant for major depression in her mother. Mental status examination revealed ego-dystonic blasphemous thoughts, intrusive imagery, compulsive checking, ideas of helplessness, and anxious affect. She was diagnosed with OCD with mixed obsessional thoughts and acts as per the International Classification of Diseases, 10th edition. The patient was started on 5 mg of Escitalopram, which was planned to increase to 20 mg daily gradually and 0.5 mg of Clonazepam. An endocrinology consultation was sought for hypothyroidism, and she was advised to continue 50 mg of Thyroxine.</p><p id="para0005" class="elsevierStylePara elsevierViewall">A week later, the patient presented to the emergency department with complaints of sudden onset of slurring speech, headache, difficulty walking, tremors of both upper and lower limbs, confusion, disorientation, and visual hallucinations. Electroencephalogram was suggestive of mild encephalopathy. Magnetic Resonance Imaging (MRI) of the brain revealed a well-defined, intra-axial lesion measuring 2.8 × 3.1 × 4.2 cm involving the left hippocampus. The lesion was heterogeneously hypointense on T1 weighted images and heterogeneously hyperintense on T2 images with a characteristic “bubbly appearance”, with no blooming, no restriction on diffusion sequences and showing rim enhancement (<a class="elsevierStyleCrossRef" href="#fig0001">Fig. 1</a> A-C). The patient was then referred to Neurosurgery. Left anterior temporal lobectomy and hippocampectomy with complete lesion removal was performed. Histopathological examination showed features suggestive of DNET. A month later, the patient reported significant improvement in intrusive imagery, blasphemous thoughts, pathological doubts, compulsive behavior and the associated distress. The scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) before and after the surgery were 22 and 10, respectively. She had repetitive doubts about her health status with mild distress, so 5 mg of Escitalopram was continued. Six months after the surgery, she had persistent anxiety about her health, and there was a significant improvement in other obsessive-compulsive symptoms. A neuropsychological assessment revealed deficits in sustained attention, verbal fluency, and verbal episodic memory. Escitalopram was increased to 15 mg per day, and applied relaxation techniques and home-based cognitive rehabilitation strategies were taught to the patient. There has been significant improvement in her functioning.</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Discussion</span><p id="para0006" class="elsevierStylePara elsevierViewall">Our report illustrates the association between obsessive-compulsive symptoms and left temporal DNET and the psychiatric outcome after surgical resection. Many structural and functional neuroimaging studies have demonstrated alterations in the cortico-striato-thalamo-cortical (CSTC) circuits implicated in cognitive, behavioral and motivational processes in OCD.<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> With its afferent and efferent connections with the orbitofrontal cortex, medial prefrontal cortex and ventral striatum, the temporal lobe forms an integral part of neuroanatomical correlates of OCD.<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> Temporal lobe atrophy has been implicated in the compulsive behaviors observed in frontotemporal dementia.<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Similarly, temporal lobe epilepsy is another condition associated with obsessive-compulsive symptoms.<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Owing to the high prevalence of refractory epilepsy in patients with temporal lobe DNET, inter-ictal psychiatric disorders are common in these patients.<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> There have been reports of DNET presenting with atypical features like major depressive and schizophreniform features.<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> Our case highlights a novel association between temporal lobe DNET and OCD.</p></span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Ethical considerations</span><p id="para0007" class="elsevierStylePara elsevierViewall">Written informed consent was taken from the patient for publishing this report.</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Funding</span><p id="para0008" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0001" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "sec0002" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0003" "titulo" => "Ethical considerations" ] 3 => array:2 [ "identificador" => "sec0004" "titulo" => "Funding" ] 4 => array:2 [ "identificador" => "xack644538" "titulo" => "Acknowledgment" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-09-06" "fechaAceptado" => "2022-09-20" "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1129 "Ancho" => 3000 "Tamanyo" => 270954 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Axial MR images showing a well-defined intra-axial lesion with a bubbly appearance in the left hippocampus, which is heterogeneously hypointense on T1 (A), heterogeneously hyperintense on T2 (B) and FLAIR images (C).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obsessive–compulsive disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.J. Stein" 1 => "D.L.C. Costa" 2 => "C. Lochner" ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1038/s41572-018-0051-2" "Revista" => array:7 [ "tituloSerie" => "Nat Rev Dis Primers. [Internet]" "fecha" => "2019" "volumen" => "5" "numero" => "1" "paginaInicial" => "1" "paginaFinal" => "21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30617281" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1038/s41572-018-0051-2" "WWW" => array:1 [ "link" => "https://doi.org/10.1038/s41572-019-0102-3" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etiology of obsessions and compulsions: a meta-analysis and narrative review of twin studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Taylor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cpr.2011.09.008" "Revista" => array:7 [ "tituloSerie" => "Clin Psychol Rev" "fecha" => "2011" "volumen" => "31" "numero" => "8" "paginaInicial" => "1361" "paginaFinal" => "1372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22024245" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0003" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurosurgical targets for compulsivity: what can we learn from acquired brain lesions?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Figee" 1 => "I. Wielaard" 2 => "A. Mazaheri" 3 => "D. Denys" ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/j.neubiorev.2013.01.005" "Revista" => array:7 [ "tituloSerie" => "Neurosci Biobehav Rev. [Internet]" "fecha" => "2013" "volumen" => "37" "numero" => "3" "paginaInicial" => "328" "paginaFinal" => "339" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23313647" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/j.neubiorev.2013.01.005" "WWW" => array:1 [ "link" => "https://doi.org/10.1016/j.neubiorev.2013.01.005" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0004" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obsessive–compulsive symptoms in neurologic disease: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.S. George" 1 => "J.A. Melvin" 2 => "C.H. Kellner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Behavioural Neurol" "fecha" => "1992" "volumen" => "5" "numero" => "1" "paginaInicial" => "3" "paginaFinal" => "10" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0005" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dysembryoplastic neuroepithelial tumors: what you need to know" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Luzzi" 1 => "A. Elia" 2 => "M. del Maestro" ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/j.wneu.2019.04.056" "Revista" => array:6 [ "tituloSerie" => "World Neurosurg.[Internet]" "fecha" => "2019" "volumen" => "127" "paginaInicial" => "255" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30981794" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/j.wneu.2019.04.056" "WWW" => array:1 [ "link" => "https://doi.org/10.1016/j.wneu.2019.04.056" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0006" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brain circuitry of compulsivity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "O.A. van den Heuvel" 1 => "G. van Wingen" 2 => "C. Soriano-Mas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.euroneuro.2015.12.005" "Revista" => array:7 [ "tituloSerie" => "Eur Neuropsychopharmacol" "fecha" => "2016" "volumen" => "26" "numero" => "5" "paginaInicial" => "810" "paginaFinal" => "827" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26711687" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0007" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complex compulsive behaviour in the temporal variant of frontotemporal dementia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.M. Rosso" 1 => "G. Roks" 2 => "M. Stevens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s004150170049" "Revista" => array:7 [ "tituloSerie" => "J Neurol" "fecha" => "2001" "volumen" => "248" "numero" => "11" "paginaInicial" => "965" "paginaFinal" => "970" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11757960" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0008" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obsessive-compulsive symptoms in patients with temporal lobe epilepsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.L. Isaacs" 1 => "J.W. Philbeck" 2 => "W.B. Barr" 3 => "O. Devinsky" 4 => "K. Alper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.yebeh.2004.04.009" "Revista" => array:7 [ "tituloSerie" => "Epilepsy Behav" "fecha" => "2004" "volumen" => "5" "numero" => "4" "paginaInicial" => "569" "paginaFinal" => "574" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15256195" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0009" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychiatric comorbidity in temporal DNET and improvement after surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Landais" 1 => "A. Crespel" 2 => "J.L. Moulis" 3 => "P. Coubes" 4 => "P. Gelisse" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurochirurgie" "fecha" => "2016" "volumen" => "62" "numero" => "3" "paginaInicial" => "165" "paginaFinal" => "170" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0010" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Depression associated with dysembryoblastic neuroepithelial tumor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Lingeswaran" 1 => "D. Barathi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0253-7176.106028" "Revista" => array:7 [ "tituloSerie" => "Indian J Psychol Med" "fecha" => "2012" "volumen" => "34" "numero" => "3" "paginaInicial" => "273" "paginaFinal" => "275" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23439941" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack644538" "titulo" => "Acknowledgment" "texto" => "<p id="para0010" class="elsevierStylePara elsevierViewall">None.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/02136163/0000003700000001/v1_202301030654/S0213616322000763/v1_202301030654/en/main.assets" "Apartado" => array:4 [ "identificador" => "75941" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/02136163/0000003700000001/v1_202301030654/S0213616322000763/v1_202301030654/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213616322000763?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 2 | 8 |
| 2024 October | 37 | 5 | 42 |
| 2024 September | 39 | 1 | 40 |
| 2024 August | 34 | 2 | 36 |
| 2024 July | 40 | 5 | 45 |
| 2024 June | 54 | 21 | 75 |
| 2024 May | 44 | 7 | 51 |
| 2024 April | 24 | 9 | 33 |
| 2024 March | 22 | 1 | 23 |
| 2024 February | 38 | 1 | 39 |
| 2024 January | 15 | 2 | 17 |
| 2023 March | 1 | 0 | 1 |