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Original article
Lobar intracerebral haemorrhage: Analysis of a series and characteristics of patients receiving antiplatelet or anticoagulation treatment
Hemorragia intracerebral lobular: análisis de una serie y características en pacientes antiagregados y anticoagulados
J. Romero Lópeza,
Corresponding author
jesus.Romero.Lopez@Sergas.Es

Corresponding author.
, J.L. Maciñeiras Monteroa, M. Fontanillo Fontanillob, D. Escriche Jaimea, M.J. Moreno Carreteroa, E. Corredera Garcíaa
a Sección de Neurología, Hospital do Meixoeiro (CHUVI), Vigo, Pontevedra, Spain
b Unidad de Apoyo a la Investigación, Hospital do Meixoeiro (CHUVI), Vigo, Pontevedra, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Due to their specific location&#44; aetiology&#44; and prognosis&#44; lobar intracerebral haemorrhages &#40;LICH&#41; are different from other types of intracerebral haemorrhages &#40;ICH&#41;&#46; According to different series&#44; they account for 14&#37;&#8211;39&#37; of all ICH&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;5</span></a> LICH occurs in the cortical&#8211;subcortical junction of the cerebral lobes and usually extends along a plane parallel to the adjacent cerebral cortex&#46; It may affect any of the cerebral lobes&#44; but it most commonly presents in one or more lobes of the parietal-occipital-temporal association area&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;5</span></a> The various causes of LICH coincide with the aetiologies of other types of ICH&#59; in LICH&#44; however&#44; high blood pressure plays a less important role and cerebral amyloid angiopathy &#40;CAA&#41; appears more frequently&#46; Although high blood pressure causes 80&#37; of basal ganglia haemorrhages&#44; it only occurs in 30&#37;&#8211;50&#37; of LICH cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;8</span></a> Other aetiological factors&#44; such as arteriovenous malformations&#44; occur in 7&#37;&#8211;20&#37; of LICH cases&#59; tumours are present in 7&#37;&#8211;9&#37;&#44; and blood or clotting disorders are found with 5&#37;&#8211;20&#37; cases of haemorrhages&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;5&#44;9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The purpose of this study is to evaluate a consecutive series of 162 patients with LICH and analyse LICH patient subgroups with a prior history of antiplatelet or anticoagulation treatment&#46; We recorded demographic&#44; aetiological&#44; and clinical differences&#44; outcome&#44; and the bleeding volume plus its predictive value for mortality&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a retrospective study of a series of 162 consecutive LICH patients drawn from a database of stroke patients admitted to the neurology department at Hospital Meixoeiro in Vigo &#40;CHUVI&#41; between January 1991 and December 2009&#46; Stroke subtypes were classified according to the guidelines drawn up by the Spanish Society of Neurology&#39;s Cerebrovascular Diseases Study Group&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> All patients in the series were admitted to the neurology department in the first 24 h after symptom onset&#46; They were diagnosed and monitored by one of the department&#39;s neurologists according to the Spanish Society of Neurology&#39;s stroke care protocols&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Patients cared for by other departments were not included in the study&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Patients were diagnosed with LICH if they had non-traumatic intraparenchymal haemorrhages and met the following criteria&#58; &#40;a&#41; medical history&#44; examination and brain CT compatible with intracerebral haemorrhage&#59; &#40;b&#41; primary location of the haemorrhage in the cortical or cortical&#8211;subcortical region&#44; in one or more cerebral lobes &#40;in some cases&#44; it was difficult to distinguish between lobar and deep cerebral haemorrhages&#46; Those located within 1<span class="elsevierStyleHsp" style=""></span>cm of the lateral ventricular wall were considered deep or basal ganglia haemorrhages&#59; when the haemorrhage location was unclear&#44; the CT scan was reviewed by a group of neurologists and radiologists in order to reach a consensus&#41;&#46; Some included cases also featured &#40;c&#41; cortical vessel rupture with bleeding into the subarachnoid space or ventricular invasion&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The following exclusion criteria were applied&#58; traumatic LICH&#44; LICH secondary to an arteriovenous malformation bleed&#44; cavernous haemangioma&#44; primary or metastatic brain tumours&#44; and cerebral infarctions with haemorrhagic conversion&#46; Cases of LICH associated with subarachnoid haemorrhage were included when the latter was found to be secondary to the lobar haemorrhage and not associated with aneurysm or arteriovenous malformation&#46; In all patients&#44; we ruled out the presence of an underlying pathology behind the haemorrhage with the aid of subsequent neuroimaging studies &#40;CT scan or brain MRI&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The data collection protocol included the following&#58; age&#44; sex&#44; and intracerebral haemorrhage risk factors according to international criteria&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;10&#44;11</span></a> Diagnosis of any risk factor or factors and their treatment at the time of the haemorrhage had to be recorded in the patient&#39;s medical history&#46; We also recorded clinical manifestations upon admission&#44; possible aetiology or aetiologies of LICH indicated by the neurologist on the patient&#39;s discharge report&#44; and outcome as either death or survival&#46; LICH cases associated with possible&#44; probable&#44; or definite diagnoses of CAA were classified according to the Boston CAA Group guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> We specifically recorded prior treatment with oral antiplatelet and anticoagulation agents&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">All patients had a brain CT scan taken during the first 6 h after admission&#46; Bleed volume was measured using the standard formula for volume &#40;cc&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">A</span>&#183;<span class="elsevierStyleItalic">B</span>&#183;<span class="elsevierStyleItalic">C</span>&#47;2 &#40;where <span class="elsevierStyleItalic">A</span> is the largest cross-sectional diameter of the haemorrhage in cm&#44; <span class="elsevierStyleItalic">B</span> is the largest diameter perpendicular to <span class="elsevierStyleItalic">A</span>&#44; and <span class="elsevierStyleItalic">C</span> is the number of 1-cm tomographic slices intersecting the haemorrhage&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The CT scanners used during these years were ProSpeed&#44; HiSpeed Spiral and Lightspeed VCT models built by General Electric&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Certain patients had a brain MRI taken between the first and the sixth month after the haemorrhage so as to rule out LICH secondary to an underlying lesion&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Within this series&#44; we analysed two subgroups&#58; LICH patients previously treated with the anticoagulation agent Sintrom<span class="elsevierStyleSup">&#174;</span> and patients previously treated with antiplatelet agents &#40;aspirin&#44; triflusal&#44; or clopidogrel&#41;&#46; We compared patients&#8217; different demographic&#44; clinical and aetiological variables&#44; as well as the bleed volume in the 2 subgroups&#44; to patients with LICH who had not received antiplatelet or anticoagulation agents&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Statistical analysis was performed with the Statistical Package for Social Sciences programme version 15&#46;0 &#40;SPSS&#44; Chicago&#44; United States&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We performed a descriptive analysis of the variables included in the study&#46; For qualitative variables&#44; we used frequencies and percentages&#44; and for quantitative variables&#44; we used standard deviation&#44; range&#44; median&#44; and interquartile range&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We used the <span class="elsevierStyleItalic">t</span> test to compare ages between the 2 patient subgroups receiving anticoagulation and antiplatelet agents&#46; In the overall series&#44; the <span class="elsevierStyleItalic">t</span> test was also used to compare patients with no anticoagulation and antiplatelet agents with those receiving either anticoagulation or antiplatelet agents&#46; We used the median test to measure the haemorrhage volume shown by the CT scan in each of the different patient subgroups&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">We compared risk factors&#44; clinical data&#44; and aetiology among different patient subgroups using univariate analysis &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test or Fisher&#39;s exact test&#41;&#46; The Kolmogorov&#8211;Smirnov test was used to study normality&#46; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05 was considered statistically significant&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The variables best predicting risk of death were determined by means of a backward stepwise logistic regression model based on the maximum likelihood method&#46; Death was considered the dependent variable &#40;coded as 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>yes&#44; 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>no&#41;&#46; Covariates were those shown to be clinically relevant or significant in the univariate analysis&#46; The odds ratio &#40;OR&#41; and 95&#37; confidence interval were estimated based on the coefficients and standard deviations&#46; Sensitivity and specificity of the bleed volume with respect to death were determined by using receiver operating characteristic &#40;ROC&#41; curves to determine the best cut-off point&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 5248 stroke patients were treated by the Hospital Meixoeiro neurology department between January 1991 and December 2009&#46; Of these patients&#44; 994 &#40;18&#46;9&#37;&#41; were diagnosed with ICH&#46; The ICH group included 162 patients with LICH&#46; That subgroup comprised 16&#46;4&#37; of the patients with ICH and 3&#37; of the total stroke patients treated in this department&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Results of the retrospective analysis of the general series of 162 LICH patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Of the LICH patient total&#44; 54&#37; were women and the mean age of both sexes was 73&#46;7 years&#44; with a range of 35&#8211;95 years&#46; Women had a mean age of 76&#46;3 with a range of 35&#8211;93 years&#44; while men had a mean age of 70&#46;8 with a range of 40&#8211;95 years&#46; Vascular risk factors&#44; aetiology&#44; symptoms&#44; outcome &#40;death&#47;survival&#41;&#44; and haemorrhage volume measured by CT are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Since LICH may have multiple causes&#44; we determined the number of patients with both high blood pressure and CAA&#44; and the combination of HBP&#44; CAA&#44; and antiplatelet or anticoagulation therapy&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The results of the subgroups of patients who received antiplatelet agents &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41; or anticoagulation agents &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; prior to LICH are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The table also displays age and sex distribution&#44; vascular risk factors&#44; aetiology&#44; clinical characteristics&#44; outcome&#44; and bleeding volume&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Patients treated with Sintrom<span class="elsevierStyleSup">&#174;</span> upon arrival at the emergency department had an anticoagulation level of 3&#46;26 &#40;measured by the International Normalised Ratio&#44; INR&#41; with a range of 1&#46;35&#8211;11&#46;28 and a typical deviation of 2&#46;4&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Comparison of both subgroups revealed significant age-related differences between women receiving antiplatelet agents and those treated with anticoagulation agents&#46; As we might expect&#44; heart disease is significantly more common among patients receiving anticoagulation agents&#46; The presence of high blood pressure&#44; diabetes mellitus type 2 &#40;DM 2&#41;&#44; and death was also significant&#46; Deaths were more frequent in the group of patients receiving anticoagulation agents&#46; Haemorrhage volume was larger in the patients receiving anticoagulation agents&#44; but the difference was not significant&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The comparative analysis between the general LICH series &#40;excluding patients treated with antiplatelet or anticoagulation agents&#41; and the group of patients receiving anticoagulation agents &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; revealed significant differences related to age&#44; but not to sex&#46; Heart disease was also significantly more frequent in the group of patients receiving anticoagulation agents&#44; as was to be expected&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">There were no significant differences for the other vascular risk factors except for DM 2&#46; There were also no significant differences between the 2 subgroups with regard to aetiology and symptoms&#46; Deaths were more frequent in the group of patients treated with anticoagulation agents&#46; However&#44; this result was not significant compared to the group of LICH patients without antiplatelet or anticoagulation treatment&#46; Nevertheless&#44; the median haemorrhage volume was 3 times higher in the patient subgroup treated with anticoagulation agents&#44; and the difference was clearly significant &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In our series&#44; the median haemorrhage volume was 30&#46;2<span class="elsevierStyleHsp" style=""></span>cc&#46; In our patients&#44; the volume of the CT scan had a high predictive value for death &#40;area under the ROC curve&#44; 0&#46;88&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; The cut-off point was 37&#46;8<span class="elsevierStyleHsp" style=""></span>cc &#40;sensitivity 78&#37; and specificity 72&#37;&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In the group of patients receiving antiplatelet agents&#44; the median volume was 41&#46;5<span class="elsevierStyleHsp" style=""></span>cc&#46; In LICH patients who did not receive antiplatelet or anticoagulation agents&#44; median volume was 27&#46;8<span class="elsevierStyleHsp" style=""></span>cc&#46; This difference was significant &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; In this subgroup&#44; the cut-off point for death was a bleeding volume of 58<span class="elsevierStyleHsp" style=""></span>cc&#44; with a sensitivity of 100&#37; and a specificity of 76&#37; &#40;area under the ROC curve&#44; 1&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">There was no relationship between INR &#40;mean&#44; 3&#46;2&#41; upon arrival at the hospital and haemorrhage volume in the anticoagulation group&#46; One patient had an INR of 11&#46;28 and a haemorrhage volume of 84<span class="elsevierStyleHsp" style=""></span>cc&#44; and another patient had an INR of 2&#46;7 and a haemorrhage volume of 283<span class="elsevierStyleHsp" style=""></span>cc&#46; Haemorrhage volume also had a low predictive value for death in this subgroup since the area under the ROC curve was only 0&#46;68&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">According to the multivariate logistic regression analysis of the general series&#44; there was a significant association between death and the variables sex and haemorrhage volume quantified by CT&#46; OR for haemorrhage volume was 1&#46;032&#44; and OR for female sex was 5&#46;37 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; In the anticoagulation group&#44; there was no significant link between bleeding volume and death due to the dispersion of the data and the low number of patients&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">Between 1991 and 2009&#44; LICH accounted for 3&#37; of the total stroke patients treated in the neurology department at Hospital Meixoeiro&#44; Vigo&#44; Spain&#59; this figure was similar to that reported in another study&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> LICH also accounted for 16&#46;4&#37; of the total ICH patients attended&#44; a lower percentage than that reported by other published studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;14</span></a> In our study&#44; females are slightly predominant and mean age is similar to that in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;15</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Vascular risk factors recorded in our series are similar to those in the literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> with the exception of one series with an increased incidence of high blood pressure&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> There were no significant differences between the patient subgroup treated with antiplatelet agents and the subgroup on anticoagulation agents except that heart disease was more frequent in the second group&#44; which was to be expected&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In our general series&#44; the frequency of clinical manifestations &#40;hemiparesis&#44; aphasia&#44; and changes in alertness&#41; was similar to those listed in other series of LICH patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4&#44;8&#44;9</span></a> Headache frequency&#44; however&#44; was lower among our patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> Our study found no significant differences in clinical presentation between the general series and the LICH patient subgroups treated with antiplatelet and anticoagulation agents&#44; or between the last two subgroups&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">We found a high mortality rate for LICH &#40;25&#37; in our series&#41; which was very similar to rates given in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5&#44;7</span></a> This study found no significant differences for percentage of deaths between the general series without antiplatelet and anticoagulation agents &#40;114 patients&#41; and the patient subgroup treated with antiplatelet agents &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Comparing the general series with the patient group on anticoagulation agents shows that the mortality rate is almost twice as high in the anticoagulation group&#46; This rate approaches statistical significance but does not reach it&#44; probably due to the low number of patients in the anticoagulation group &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; There are more deaths in the anticoagulation group than in the antiplatelet group &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; but the difference is not significant&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The literature does not report the incidence of death in LICH patients previously treated with antiplatelet or anticoagulation agents&#44; which is why our study provides a novel contribution&#46; However&#44; we found one study of a series of ICH patients previously treated with antiplatelet agents in which the in-hospital mortality rate was nearly identical to the one in our antiplatelet subgroup &#40;about 25&#37; in both studies&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> There are also series of ICH cases associated with anticoagulation in which in-hospital mortality rates are quite similar to the one in our anticoagulation subgroup &#40;between 35&#37; and 45&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#8211;19</span></a> The aetiologies &#40;or combinations of aetiologies&#41; underlying LICH were similar to those in other published series&#58; high blood pressure&#44; diabetes&#44; heart disease&#44; prior stroke&#44; and dyslipidaemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;5</span></a> According to the Boston CAA Group guidelines&#44; the presence of possible or probable CAA &#40;close to 75&#37;&#41; was similar to that reported by a study including an anatomical pathology assessment&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> This highlights the important role that disease plays in lobar haemorrhages&#46; Incidence of CAA was similar to the above study in the antiplatelet patient group&#44; but lower in the anticoagulation group&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In our series&#44; the median bleeding volume was 30&#46;2<span class="elsevierStyleHsp" style=""></span>cc&#44; slightly lower than the volume in an earlier series published by our group&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and also lower than the volumes reported in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;15&#44;20</span></a> As we stated in another previous study&#44; the haemorrhage volume quantified by CT upon admission showed a high predictive value for death in the overall series&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">We also found that haemorrhage volume had a high predictive value for death&#44; with a cut-off point of 58<span class="elsevierStyleHsp" style=""></span>cc&#44; in the patient group treated with antiplatelet agents&#46; This is a new finding which is relevant for managing LICH and for potential approaches to treatment&#46; However&#44; the same result could not be demonstrated in the anticoagulation group since this patient subgroup was quite small and bleeding volumes varied greatly&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The considerable difference between mean haemorrhage volume in the patient subgroup without antiplatelet or anticoagulation agents and the antiplatelet patient subgroup &#40;27&#46;8<span class="elsevierStyleHsp" style=""></span>cc versus 41&#46;5<span class="elsevierStyleHsp" style=""></span>cc&#41; may be explained by the action of the antiplatelet agents&#44; and also in part by the significant age difference between groups&#46; It was recently determined that LICH volume is related to age&#46; The older the patient is&#44; the larger the bleed volume&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">CAA is the most frequent cause of LICH<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;12</span></a> and it is associated with ApoE alleles ¿2 and ¿4&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> It is often present in patients with Alzheimer disease&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Brain microbleeds&#44; especially those located in the cortex&#44; can be detected by using gradient echo MR imaging&#46; They are indicative of CAA&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a> It is also known that these microbleeds are predictors of a greater tendency towards LICH in patients treated with anticoagulation agents&#46; Elderly patients should therefore be checked for microbleeds prior to anticoagulation treatment&#44; and presence of microbleeds must be factored into the risk-benefit ratio for anticoagulation&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;24</span></a> It was recently shown that antiplatelet treatment with aspirin in LICH patients may increase the risk of bleed recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Our study has a number of limitations since it is a retrospective series spanning 19 years&#46; Patients were not monitored after discharge&#44; which is why we have no information regarding long-term outcomes&#44; bleed recurrences&#44; or other potentially interesting variables&#46; The small size of the LICH patient subgroup treated with anticoagulation agents does not permit us to gather significant data&#46; However&#44; death rates in this group are much higher than in the rest of the series&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Our study reveals interesting information on LICH aetiology&#44; clinical manifestations&#44; and the differences in death rate associated with prior use of antiplatelet or anticoagulation agents&#46; We also feel that it would be interesting to define cut-off points for haemorrhage volume that would enable us to predict patient mortality in the different subgroups under study&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => "Anticoagulation"
            1 => "Antiplatelet"
            2 => "Lobar intracerebral haemorrhage"
            3 => "Prognostic variables"
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            0 => "Anticoagulaci&#243;n"
            1 => "Antiagregaci&#243;n"
            2 => "Hemorragia intracerebral lobular"
            3 => "Variables pron&#243;sticas"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lobar intracerebral haemorrhage &#40;LICH&#41; is a rare cause of stroke which accounts for about 20&#37; of primary intracerebral haemorrhages&#46; The most common causes are cerebral amyloid angiopathy &#40;CAA&#41;&#44; high blood pressure and others&#44; such as using antiplatelet or anticoagulation agents&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We analysed a series of patients with LICH and compared it with subgroups of patients with LICH who were previously receiving antiplatelet or anticoagulation agents&#46; We determined the volume of the bleeding and its predictive value for mortality&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We consecutively and retrospectively included 162 patients diagnosed with LICH and cared for in the Neurology Department of Hospital Meixoeiro in Vigo between 1991 and 2009&#46; We collected demographic characteristics&#44; risk factors&#44; aetiologies and symptoms&#44; and conducted a comparative analysis between the general series and the subgroups of patients receiving anticoagulation and antiplatelet agents&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In the general series&#44; the most common cause was possible or probable CAA followed by hypertension&#46; In the subgroup of patients receiving antiplatelet or anticoagulation agents there were no differences in the variables studied&#44; except for the frequency of heart disease&#46; Nonetheless&#44; there were differences with respect to age&#44; heart disease and bleeding volume between the general series &#40;patients not treated with antiplatelet or anticoagulation agents&#41; when compared with the subgroups of patients receiving antiplatelet and anticoagulation agents&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We provide new information regarding the clinical behaviour of LICH and its differences in patients receiving antiplatelet or anticoagulation agents&#46; Mortality is higher in cases of LICH on anticoagulants&#46; Female sex and the volume of bleeding are predictors of mortality&#46;</p>"
      ]
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La hemorragia intracerebral lobular &#40;HIL&#41; es una causa poco frecuente de ictus y representan cerca del 20&#37; de las hemorragias intracerebrales primarias&#46; La causa m&#225;s frecuente son la angiopat&#237;a amiloidea cerebral &#40;AAC&#41;&#44; la hipertensi&#243;n arterial &#40;HTA&#41; y otras como el tratamiento antiagregante o anticoagulante&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analizar una serie de pacientes con HIL y compararla con subgrupos de pacientes con HIL antiagregados o anticoagulados previamente&#46; Determinar el volumen de la hemorragia y su valor predictivo de mortalidad&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; de forma consecutiva y retrospectiva a 162 pacientes diagnosticados de HIL y atendidos en el servicio de neurolog&#237;a del Hospital Meixoeiro de Vigo entre los a&#241;os 1991 y 2009&#46; Se recogieron caracter&#237;sticas demogr&#225;ficas&#44; factores de riesgo&#44; etiolog&#237;as y cl&#237;nica&#44; y se realiz&#243; un an&#225;lisis comparativo entre la serie general y los subgrupos de paciente antiagregados y anticoagulados&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En la serie general la causa m&#225;s frecuente fue la AAC posible o probable seguida de la HTA&#46; En los subgrupos de pacientes antiagregados o anticoagulados no hab&#237;a diferencias en las variables estudiadas excepto en la frecuencia de cardiopat&#237;a&#46; S&#237; exist&#237;an diferencias en cuanto a la edad&#44; la cardiopat&#237;a y la volumen de la hemorragia entre la serie general &#40;sin los pacientes antiagregados o anticoagulados&#41; cuando se compararon con los subgrupos de antiagregados y anticoagulados&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Aportamos algunas novedades respecto al comportamiento cl&#237;nico de la HIL y sus diferencias en los pacientes antiagregados o anticoagulados&#46; La mortalidad es superior en las HIL anticoaguladas&#46; Son variables predictivas de defunci&#243;n el sexo femenino y el volumen de la hemorragia&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Romero L&#243;pez J&#44; et al&#46; Hemorragia intracerebral lobular&#58; an&#225;lisis de una serie y caracter&#237;sticas en pacientes antiagregados y anticoagulados&#46; Neurolog&#237;a&#46; 2012&#59;27&#58;387&#8211;93&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">CAA&#58; cerebral amyloid angiopathy&#59; SD&#58; standard deviation&#59; DM 2&#58; type 2 diabetes mellitus&#59; HBP&#58; high blood pressure&#59; IQR&#58; interquartile range&#59; CT scan&#58; computed tomography &#40;brain&#41;&#46;</p>"
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Demographic factors</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Females&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;53&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean age</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#59; range&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;3&#59; &#40;35&#8211;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean age</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#59; range&#44; years &#40;female&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;4&#59; &#40;35&#8211;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean age</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#59; range&#44; years &#40;male&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;6&#59; &#40;40&#8211;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Cardiovascular risk factors&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">HBP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;45&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Prior stroke</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;22&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Antiplatelet drugs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;19&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Heart disease</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;17&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DM 2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;12&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Alcohol</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;7&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dyslipidaemia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;8&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anticoagulation agents</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Smoking</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Blood clotting disorders</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DM</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Aetiologies&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">HBP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;45&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CAA</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Possible&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106 &#40;65&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Probable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anticoagulation agents</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Antiplatelet therapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;19&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Alcohol abuse</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">HBP</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CAA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;32&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">HBP</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CAA</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">anticoagulation agents</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">HBP</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CAA</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">antiplatelet agents</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Clinical characteristics&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hemiparesis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89 &#40;54&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Aphasia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Median volume by CT &#40;IQR&#41;&#44; cc&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">5 &#40;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;31&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">1 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Possible&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Probable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;40&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;31&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;21&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Headache</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;28&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;37&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;509&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hemianopia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;772&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Drowsiness</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;610&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Stupor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;18&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;563&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Death</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;43&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Median volume in CT scan &#40;IQR&#41;&#44; cc</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78 &#40;38&#46;8&#8211;122&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
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                0 => "xTab264936.png"
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                    0 => array:1 [
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                          "etal" => true
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                            3 => "M&#46;A&#46; Foulkes"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos