metricas
covid
Buscar en
Neurología (English Edition)
Toda la web
Inicio Neurología (English Edition) Unilateral cerebral amyloid angiopathy after neurointervention
Journal Information

Statistics

Follow this link to access the full text of the article

Letter to the Editor
Unilateral cerebral amyloid angiopathy after neurointervention
Angiopatía amiloide cerebral unilateral tras una neurointervención
A. Lázaro Romero
Corresponding author
albalazaroromero@gmail.com

Corresponding author.
, C. Moreno Loscertales, E. Marta Moreno
Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
Read
1849
Times
was read the article
283
Total PDF
1566
Total HTML
Share statistics
 array:25 [
  "pii" => "S2173580822000293"
  "issn" => "21735808"
  "doi" => "10.1016/j.nrleng.2021.05.009"
  "estado" => "S300"
  "fechaPublicacion" => "2022-05-01"
  "aid" => "1635"
  "copyright" => "Sociedad Española de Neurología"
  "copyrightAnyo" => "2021"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "cor"
  "cita" => "Neurologia. 2022;37:310-2"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S0213485321000980"
      "issn" => "02134853"
      "doi" => "10.1016/j.nrl.2021.05.006"
      "estado" => "S300"
      "fechaPublicacion" => "2022-05-01"
      "aid" => "1635"
      "copyright" => "Sociedad Española de Neurología"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "cor"
      "cita" => "Neurologia. 2022;37:310-2"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>"
        "titulo" => "Angiopat&#237;a amiloide cerebral unilateral tras una neurointervenci&#243;n"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "310"
            "paginaFinal" => "312"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Unilateral cerebral amyloid angiopathy after neurointervention"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 873
                "Ancho" => 755
                "Tamanyo" => 83670
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">RMN cerebral y SWI&#46; Se aprecian numerosos focos puntiformes de sangrado en l&#243;bulo parietal&#44; en menor cantidad frontal posterior y alguno aislado en l&#243;bulo occipital&#44; todos en el lado izquierdo&#44; as&#237; como fino ribete de hipose&#241;al en espacio subaracnoideo a nivel de cisura de Rolando en relaci&#243;n con siderosis leptomen&#237;ngea&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "A&#46; L&#225;zaro Romero, C&#46; Moreno Loscertales, E&#46; Marta Moreno"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "L&#225;zaro Romero"
              ]
              1 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Moreno Loscertales"
              ]
              2 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Marta Moreno"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173580822000293"
          "doi" => "10.1016/j.nrleng.2021.05.009"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580822000293?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485321000980?idApp=UINPBA00004N"
      "url" => "/02134853/0000003700000004/v2_202205041935/S0213485321000980/v2_202205041935/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2173580822000281"
    "issn" => "21735808"
    "doi" => "10.1016/j.nrleng.2021.05.008"
    "estado" => "S300"
    "fechaPublicacion" => "2022-05-01"
    "aid" => "1634"
    "copyright" => "Sociedad Espa&#241;ola de Neurolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Neurologia. 2022;37:313-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Acute disseminated encephalomyelitis after <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> infection&#58; unfavourable clinical course&#44; excellent recovery"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "313"
          "paginaFinal" => "315"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Encefalomielitis aguda diseminada tras infecci&#243;n por <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span>&#58; evoluci&#243;n t&#243;rpida&#44; recuperaci&#243;n excelente"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 835
              "Ancho" => 1255
              "Tamanyo" => 97168
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Brain MRI scan performed during treatment with intravenous immunoglobulins&#44; showing radiological worsening despite the patient&#8217;s favourable clinical progression&#46; The scan revealed multiple hyperintensities on T2-weighted and FLAIR sequences&#44; with diffusion restriction&#59; the largest lesions involve the left basal ganglia and corticosubcortical regions bilaterally&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Rodr&#237;guez-Montolio, S&#46; Ballesta-Mart&#237;nez, Y&#46; Mart&#237;n-Alem&#225;n, E&#46; Mu&#241;oz-Farjas"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Rodr&#237;guez-Montolio"
            ]
            1 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Ballesta-Mart&#237;nez"
            ]
            2 => array:2 [
              "nombre" => "Y&#46;"
              "apellidos" => "Mart&#237;n-Alem&#225;n"
            ]
            3 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Mu&#241;oz-Farjas"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0213485321000979"
        "doi" => "10.1016/j.nrl.2021.05.005"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485321000979?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580822000281?idApp=UINPBA00004N"
    "url" => "/21735808/0000003700000004/v1_202205180543/S2173580822000281/v1_202205180543/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S217358082200030X"
    "issn" => "21735808"
    "doi" => "10.1016/j.nrleng.2021.05.010"
    "estado" => "S300"
    "fechaPublicacion" => "2022-05-01"
    "aid" => "1638"
    "copyright" => "Sociedad Espa&#241;ola de Neurolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Neurologia. 2022;37:308-10"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Primary central nervous system germinoma as a rare cause of diffuse ependymal involvement in adults"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "308"
          "paginaFinal" => "310"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Germinoma primario del sistema nervioso central como causa infrecuente de afectaci&#243;n ependimaria difusa en el adulto"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 627
              "Ancho" => 1255
              "Tamanyo" => 67467
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Brain MRI scan&#46; Axial T1-weighted fast spin-echo post-contrast sequence showing a marked increase in the size and extension of ependymal enhancement in the lateral ventricles &#40;A&#41; and the fourth ventricle &#40;B&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46; Sanesteban Beceiro, P&#46; Mayo Rodr&#237;guez, M&#46; Jorquera Moya, R&#46;C&#46; Ginestal L&#243;pez"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Sanesteban Beceiro"
            ]
            1 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Mayo Rodr&#237;guez"
            ]
            2 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Jorquera Moya"
            ]
            3 => array:2 [
              "nombre" => "R&#46;C&#46;"
              "apellidos" => "Ginestal L&#243;pez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0213485321001018"
        "doi" => "10.1016/j.nrl.2021.05.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485321001018?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217358082200030X?idApp=UINPBA00004N"
    "url" => "/21735808/0000003700000004/v1_202205180543/S217358082200030X/v1_202205180543/en/main.assets"
  ]
  "en" => array:16 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Unilateral cerebral amyloid angiopathy after neurointervention"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#58;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "310"
        "paginaFinal" => "312"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "A&#46; L&#225;zaro Romero, C&#46; Moreno Loscertales, E&#46; Marta Moreno"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "L&#225;zaro Romero"
            "email" => array:1 [
              0 => "albalazaroromero@gmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "C&#46;"
            "apellidos" => "Moreno Loscertales"
          ]
          2 => array:2 [
            "nombre" => "E&#46;"
            "apellidos" => "Marta Moreno"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Neurolog&#237;a&#44; Hospital Universitario Miguel Servet&#44; Zaragoza&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Angiopat&#237;a amiloide cerebral unilateral tras una neurointervenci&#243;n"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 984
            "Ancho" => 755
            "Tamanyo" => 51363
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Susceptibility-weighted imaging brain MRI sequence&#44; axial plane&#44; showing persistence of the haemosiderin deposits in the left parietal&#44; posterior frontal&#44; and occipital lobes and the fine subarachnoid rim suggestive of leptomeningeal siderosis&#46; No haemosiderin deposition is visible in the right hemisphere&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cerebral amyloid angiopathy &#40;CAA&#41; is characterised by the deposition of amyloid beta in the media and adventitia of cortical and leptomeningeal vessels&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It causes disruption of the vessel architecture&#44; leading to vascular rupture&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The most frequent form of presentation is lobar parenchymal haemorrhage &#40;single or multiple&#41;&#59; transient neurological focal episodes<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and cognitive impairment are other possible manifestations&#46; The appearance of multiple corticosubcortical microbleeds on gradient-echo and susceptibility-weighted imaging &#40;SWI&#41; MRI sequences is a radiological sign of amyloid vasculopathy&#46; Positron emission tomography &#40;PET&#41; studies with amyloid ligands can be useful in the detection of CAA&#44; but are unable to differentiate vascular deposition &#40;typical of CAA&#41; from parenchymal deposition &#40;characteristic of Alzheimer disease&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The risk of CAA increases with age&#44; and the condition is detected in up to 38&#37; of patients between 80 and 89 years of age and up to 42&#37; of patients over 90 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It rarely occurs in patients younger than 50 years of age&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">CAA preferentially involves certain parts of the brain&#44; such as the parietotemporal region&#44; with the middle cerebral artery being the most affected&#46; However&#44; unilateral presentation is exceptional and poorly understood&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> One hypothesis is that it corresponds to a progressive state of the CAA&#59; another is that it responds to precipitating factors that favour the deposition of amyloid beta in a lateralised pattern&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although the &#8220;experimental seeding&#8221; of amyloid beta is well understood&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> transmission of amyloid beta pathology in humans has not been reported until very recently&#46; A prion-like mechanism&#44; similar to iatrogenic Creutzfeldt-Jakob disease&#44; is thought to play a role&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We report the case of a patient with history of neurosurgery in his youth&#44; who presented recurrent lobar haematomas suggestive of CAA&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was a 52-year-old white man with no family history of neurodegenerative disease&#46; He was a smoker&#44; and presented sleep apnoea syndrome&#46; At the age of 18 years&#44; he had undergone surgical treatment of an eosinophilic granuloma in the left parietal region&#44; and did not receive subsequent radiotherapy&#46; He was assessed at 44 years of age for cognitive complaints&#59; the neuropsychological study identified no abnormalities&#46; Single photon emission computed tomography revealed cortical hypoperfusion in the posterior temporal lobe bilaterally&#46; At 50 years of age&#44; he had consulted due to self-limited episodes of dysaesthesia in the right arm and hemifacies&#46; Treatment was started with eslicarbazepine acetate due to suspicion of remote symptomatic seizures&#46; A follow-up brain MRI study showed chronic ischaemic lesions&#44; predominantly in the left hemisphere&#59; Doppler ultrasound detected no alterations in blood circulation&#46; At 52 years of age&#44; he was assessed due to sudden onset of weakness in the right hand&#46; A CT study revealed a small subacute parenchymal haematoma in the left frontal convexity&#46; In the brain MRI study &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; the SWI sequence showed numerous haemorrhagic foci in the sulci of the left frontoparietal convexity&#44; indicating leptomeningeal siderosis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Three months later&#44; the patient presented sudden worsening of the motor sequela&#59; CT revealed 2 acute haemorrhagic foci in the left frontal cortex&#46; In the subsequent MRI study &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; SWI revealed persistence of the haemosiderin deposits in the left parietal&#44; posterior frontal&#44; and occipital lobes&#44; similar to those observed in the previous study&#59; no deposits were observed in the right hemisphere&#46; No significant enhancement was observed after gadolinium administration&#46; Vascular sequences did not reveal any significant findings&#46; Coagulation and autoimmunity studies yielded normal findings&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">An <span class="elsevierStyleSup">18</span>F-flutemetamol amyloid-PET study revealed bilateral&#44; diffuse deposition throughout the cerebral cortex&#46; Analysis of cerebrospinal fluid biomarkers and ApoE genotyping were not conducted&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In a clinical exome sequencing study&#44; we analysed 6102 genes&#46; No mutations were found in those genes associated with hereditary AAC&#44; such as <span class="elsevierStyleItalic">APP</span>&#44; <span class="elsevierStyleItalic">PSEN1</span>&#44; <span class="elsevierStyleItalic">PSEN2</span>&#44; <span class="elsevierStyleItalic">ITM2B</span> &#40;or <span class="elsevierStyleItalic">BRI2</span>&#44; encoding integral membrane protein 2B&#41;&#44; and <span class="elsevierStyleItalic">CST3</span> &#40;encoding cystatin 3&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A subsequent neuropsychological study did not detect cognitive impairment&#46; The patient presented moderate difficulties in visuospatial domains&#44; which we considered to be secondary to the surgical lesion in the left parietal lobe&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Our patient would meet the modified Boston criteria for probable CAA&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> with the exception of onset after 55 years of age&#46; The siderosis detected in imaging studies may be explained by the surgical procedure itself&#44; although this would not explain the amyloid-PET findings or the recurrent lobar haematomas&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In young individuals &#40;30-57 years&#41; with early-onset CAA&#44; cases have been reported of history of brain or spinal surgery &#40;with or without a dura mater graft&#41; or another invasive procedure &#40;such as external carotid artery embolisation with dura mater extracts&#41; at least 3 decades earlier&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;14</span></a> The reported cases present generalised amyloid deposition and the characteristic clinical and imaging signs of CAA&#44; which predominantly involve the hemisphere ipsilateral to surgery&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">While prevalence of the condition is not known&#44; our case supports the hypothesis that amyloid may be transmitted through neurosurgical procedures&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;15</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The patient gave verbal &#40;by telephone&#41; rather than written consent to the publication of his case due to restrictions on in-person consultations as a result of the COVD-19 pandemic&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">This study has received no specific funding from any public&#44; commercial&#44; or non-profit organisation&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Funding"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; L&#225;zaro Romero A&#44; Moreno Loscertales C&#44; Marta Moreno E&#46; Angiopat&#237;a amiloide cerebral unilateral tras una neurointervenci&#243;n&#46; Neurolog&#237;a&#46; 2022&#59;37&#58;310&#8211;312&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 873
            "Ancho" => 755
            "Tamanyo" => 83670
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Susceptibility-weighted imaging brain MRI sequence&#44; axial plane&#46; Numerous punctiform haemorrhagic foci are observed in the parietal lobe&#44; with fewer foci in the posterior frontal lobe and only isolated foci in the occipital lobe&#44; all in the left hemisphere&#46; A fine hypodense rim is present in the subarachnoid space at the level of the Rolandic fissure&#44; indicating leptomeningeal siderosis&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 984
            "Ancho" => 755
            "Tamanyo" => 51363
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Susceptibility-weighted imaging brain MRI sequence&#44; axial plane&#44; showing persistence of the haemosiderin deposits in the left parietal&#44; posterior frontal&#44; and occipital lobes and the fine subarachnoid rim suggestive of leptomeningeal siderosis&#46; No haemosiderin deposition is visible in the right hemisphere&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging Findings of Cerebral Amyloid Angiopathy&#44; A&#946;-Related Angiitis &#40;ABRA&#41;&#44; and Cerebral Amyloid Angiopathy-Related Inflammation&#58; A Single-Institution 25-Year Experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Salvarani"
                            1 => "J&#46;M&#46; Morris"
                            2 => "C&#46; Giannini"
                            3 => "R&#46;D&#46; Brown Jr&#46;"
                            4 => "T&#46; Christianson"
                            5 => "G&#46;G&#46; Hunder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MD.0000000000003613"
                      "Revista" => array:4 [
                        "tituloSerie" => "Medicine &#40;Baltimore&#41;"
                        "fecha" => "2016"
                        "volumen" => "95"
                        "paginaInicial" => "e3613"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammatory Cerebral Amyloid Angiopathy&#44; Amyloid-&#946;-Related Angiitis&#44; and Primary Angiitis of the Central Nervous System&#58; Similarities and Differences"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Moussaddy"
                            1 => "A&#46; Levy"
                            2 => "D&#46; Strbian"
                            3 => "S&#46; Sundararajan"
                            4 => "F&#46; Berthelet"
                            5 => "S&#46; Lanthier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/STROKEAHA"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2015"
                        "volumen" => "46"
                        "paginaInicial" => "e210"
                        "paginaFinal" => "e213"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26185185"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spectrum of transient focal neurological episodes in cerebral amyloid angiopathy&#58; Multicentre magnetic resonance imaging cohort study and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Charidimou"
                            1 => "A&#46; Peeters"
                            2 => "Z&#46; Fox"
                            3 => "S&#46;M&#46; Gregoire"
                            4 => "Y&#46; Vandermeeren"
                            5 => "P&#46; Laloux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/STROKEAHA.112.657759"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2012"
                        "volumen" => "43"
                        "paginaInicial" => "2324"
                        "paginaFinal" => "2330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22798323"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cerebral amyloid angiopathy&#58; Diagnosis and potential therapies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;A&#46; Weber"
                            1 => "R&#46;K&#46; Patel"
                            2 => "H&#46;L&#46; Lutsep"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/14737175.2018.1480938"
                      "Revista" => array:6 [
                        "tituloSerie" => "Expert Rev Neurother"
                        "fecha" => "2018"
                        "volumen" => "18"
                        "paginaInicial" => "503"
                        "paginaFinal" => "513"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29792540"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lateralized Cerebral Amyloid Angiopathy presenting with recurrent Lacunar Ischemic Stroke"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Li"
                            1 => "A&#46; Al-Salaimeh"
                            2 => "E&#46; DeGrush"
                            3 => "M&#46; Moonis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.29328/journal.jnnd.1001005"
                      "Revista" => array:4 [
                        "tituloSerie" => "J Neurosci Neurol Disord"
                        "fecha" => "2017"
                        "volumen" => "1"
                        "paginaInicial" => "029032"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Autopsy study of incidence and distribution of cerebral amyloid angiopathy in Hisayama&#44; Japan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Masuda"
                            1 => "K&#46; Tanaka"
                            2 => "K&#46; Ueda"
                            3 => "T&#46; Omae"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.STR.19.2.205"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "1988"
                        "volumen" => "19"
                        "paginaInicial" => "205"
                        "paginaFinal" => "210"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3344537"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exogenous induction of cerebral beta-amyloidogenesis is governed by agent and host"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Meyer-Luehmann"
                            1 => "J&#46; Coomaraswamy"
                            2 => "T&#46; Bolmont"
                            3 => "S&#46; Kaeser"
                            4 => "C&#46; Schaefer"
                            5 => "E&#46; Kilger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1126/science.1131864"
                      "Revista" => array:6 [
                        "tituloSerie" => "Science"
                        "fecha" => "2006"
                        "volumen" => "313"
                        "paginaInicial" => "1781"
                        "paginaFinal" => "1784"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16990547"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Potential human transmission of amyloid &#946; pathology&#58; Surveillance and risks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Lauwers"
                            1 => "G&#46; Lalli"
                            2 => "S&#46; Brandner"
                            3 => "J&#46; Collinge"
                            4 => "V&#46; Compernolle"
                            5 => "C&#46; Duyckaerts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1474-4422(20)30238-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Neurol"
                        "fecha" => "2020"
                        "volumen" => "19"
                        "paginaInicial" => "872"
                        "paginaFinal" => "878"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32949547"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Iatrogenic Creutzfeldt-Jakob disease with Amyloid-&#946; pathology&#58; An international study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Cali"
                            1 => "M&#46;L&#46; Cohen"
                            2 => "S&#46; Haik"
                            3 => "P&#46; Parchi"
                            4 => "G&#46; Giaccone"
                            5 => "S&#46;J&#46; Collins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s40478-017-0503-z"
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Neuropathol Commun"
                        "fecha" => "2018"
                        "volumen" => "6"
                        "paginaInicial" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29310723"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transmission of amyloid-&#946; protein pathology from cadaveric pituitary growth hormone"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Purro"
                            1 => "M&#46;A&#46; Farrow"
                            2 => "J&#46; Linehan"
                            3 => "T&#46; Nazari"
                            4 => "D&#46;X&#46; Thomas"
                            5 => "Z&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41586-018-0790-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nature"
                        "fecha" => "2018"
                        "volumen" => "564"
                        "paginaInicial" => "415"
                        "paginaFinal" => "419"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30546139"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Iatrogenic early onset cerebral amyloid angiopathy 30 years after cerebral trauma with neurosurgery&#58; Vascular amyloid deposits are made up of both A&#946;40 and A&#946;42"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Giaccone"
                            1 => "E&#46; Maderna"
                            2 => "G&#46; Marucci"
                            3 => "M&#46; Catania"
                            4 => "A&#46; Erbetta"
                            5 => "L&#46; Chiapparini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s40478-019-0719-1"
                      "Revista" => array:3 [
                        "tituloSerie" => "Acta Neuropathol Commun"
                        "fecha" => "2019"
                        "volumen" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early onset cerebral amyloid angiopathy following childhood exposure to cadaveric dura"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:5 [
                            0 => "G&#46; Banerjee"
                            1 => "M&#46;E&#46; Adams"
                            2 => "Z&#46; Jaunmuktane"
                            3 => "G&#46; Alistair Lammie"
                            4 => "B&#46; Turner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ana.25407"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Neurol"
                        "fecha" => "2019"
                        "volumen" => "85"
                        "paginaInicial" => "284"
                        "paginaFinal" => "290"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30597599"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cerebral hemorrhagic stroke associated with cerebral amyloid angiopathy in young adults about 3 decades after neurosurgeries in their infancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:5 [
                            0 => "T&#46; Hamaguchi"
                            1 => "J&#46; Komatsu"
                            2 => "K&#46; Sakai"
                            3 => "M&#46; Noguchi-Shinohara"
                            4 => "S&#46; Aoki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jns.2019.01.051"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurol Sci"
                        "fecha" => "2019"
                        "volumen" => "399"
                        "paginaInicial" => "3"
                        "paginaFinal" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30735884"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence of amyloid-&#946; cerebral amyloid angiopathy transmission through neurosurgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:5 [
                            0 => "Z&#46; Jaunmuktane"
                            1 => "A&#46; Quaegebeur"
                            2 => "R&#46; Taipa"
                            3 => "M&#46; Viana-Baptista"
                            4 => "R&#46; Barbosa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00401-018-1822-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Neuropathol"
                        "fecha" => "2018"
                        "volumen" => "135"
                        "paginaInicial" => "671"
                        "paginaFinal" => "679"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29450646"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Role of Amyloid PET in Diagnosing Possible Transmissible Cerebral Amyloid Angiopathy in Young Adults with a History of Neurosurgery&#58; A Case Series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Michiels"
                            1 => "D&#46; Van Weehaeghe"
                            2 => "R&#46; Vandenberghe"
                            3 => "J&#46; Demeestere"
                            4 => "K&#46; Van Laere"
                            5 => "R&#46; Lemmens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000514139"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cerebrovasc Dis"
                        "fecha" => "2021"
                        "paginaInicial" => "1"
                        "paginaFinal" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35066495"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735808/0000003700000004/v1_202205180543/S2173580822000293/v1_202205180543/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9409"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003700000004/v1_202205180543/S2173580822000293/v1_202205180543/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580822000293?idApp=UINPBA00004N"
]
Article information
ISSN: 21735808
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 12 2 14
2024 October 38 20 58
2024 September 50 24 74
2024 August 34 11 45
2024 July 36 11 47
2024 June 30 4 34
2024 May 52 11 63
2024 April 39 12 51
2024 March 60 6 66
2024 February 63 7 70
2024 January 68 4 72
2023 December 58 13 71
2023 November 63 7 70
2023 October 87 19 106
2023 September 47 4 51
2023 August 53 7 60
2023 July 55 2 57
2023 June 72 9 81
2023 May 116 7 123
2023 April 63 4 67
2023 March 58 5 63
2023 February 40 9 49
2023 January 38 1 39
2022 December 36 4 40
2022 November 74 5 79
2022 October 60 8 68
2022 September 51 5 56
2022 August 40 9 49
2022 July 29 11 40
2022 June 20 9 29
2022 May 22 29 51
2022 April 2 4 6
Show all

Follow this link to access the full text of the article

es en pt

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

Are you a health professional able to prescribe or dispense drugs?

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