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Erschienen in: Journal of Neurology 12/2009

01.12.2009 | Original Communication

Sleep-related breathing disorders in acute lacunar stroke

verfasst von: Marc Bonnin-Vilaplana, Adrià Arboix, Olga Parra, Luis García-Eroles, Josep M. Montserrat, Joan Massons

Erschienen in: Journal of Neurology | Ausgabe 12/2009

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Abstract

The purpose was to examine the occurrence of sleep-related breathing disorders (SRBD) and variables related to SRBD in patients with acute lacunar stroke. In 68 consecutive patients with radiologically proven lacunes, respiratory polygraphy within the first 48 h of stroke onset was performed. SRBDs were classified according to mutually exclusive cutoff values of the apnea/hypopnea index (AHI) as mild (AHI ≥10), moderate (AHI ≥20), and severe (AHI ≥30). Variables independently associated with SRBDs were assessed by logistic regression analysis. The mean (standard deviation) AHI was 21.9 (17.4). A total of 69.1% of patients showed AHI ≥10, 44.1% AHI ≥20, and 25% AHI ≥30. Cheyne-Stokes respiration (CSR) was present in 20.6% of patients. Smoking (>20 cigarettes/day) or location of lacunes in the internal capsule or the pons was significantly more frequent in the AHI ≥10 group than in the remaining AHI groups (80.9% vs. 57.1%, P = 0.041). AHI ≥20 and AHI ≥30 occurred more frequently in smokers or in capsular or pontine lacunes than in the remaining patients (20% vs. 2.6%, P = 0.053; 29.4% vs. 3.9%, P = 0.01, respectively). In the multivariate analysis, smoking or capsular or pontine topographies were associated with AHI ≥10 [odds ratio (OR) = 3.17, 95% confidence interval (CI) 1.02–9.79; P = 0.045]. Lacunes in the internal capsule or the pons in smokers were associated with AHI ≥20 (OR = 9.25, 95% CI 1.05–81.70; P = 0.045). Smoking (OR = 19.64, 95% CI 1.68–229.85; P = 0.010) and body mass index (OR = 1.68, 95% CI 1.13–2.50; P = 0.010) were associated with AHI ≥30. Smoker patients with capsular or pontine acute lacunar stroke should be screened for SRDB.
Literatur
1.
Zurück zum Zitat Arboix A, Morcillo C, García-Eroles L, Oliveres M, Massons J, Targa C (2000) Different vascular risk factor profiles in ischemic stroke subtypes: a study from the “Sagrat Cor Hospital of Barcelona Stroke Registry”. Acta Neurol Scand 102:264–270CrossRefPubMed Arboix A, Morcillo C, García-Eroles L, Oliveres M, Massons J, Targa C (2000) Different vascular risk factor profiles in ischemic stroke subtypes: a study from the “Sagrat Cor Hospital of Barcelona Stroke Registry”. Acta Neurol Scand 102:264–270CrossRefPubMed
2.
Zurück zum Zitat Arzt M, Young T, Finn L, Skatrud JB, Douglas Bradley T (2005) Association of sleep-disordered breathing and occurrence of stroke. Am J Respir Crit Care Med 172:1447–1451CrossRefPubMed Arzt M, Young T, Finn L, Skatrud JB, Douglas Bradley T (2005) Association of sleep-disordered breathing and occurrence of stroke. Am J Respir Crit Care Med 172:1447–1451CrossRefPubMed
3.
Zurück zum Zitat Askenasy JM, Goldhamer I (1998) Sleep apnea as a feature of bulbar stroke. Stroke 19:637–639 Askenasy JM, Goldhamer I (1998) Sleep apnea as a feature of bulbar stroke. Stroke 19:637–639
4.
Zurück zum Zitat Basile AM, Pantoni L, Pracucci G, Asplund K, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, O’Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D (2006) Age, hypertension, and lacunar stroke are the major determinants of the severity of age-related white matter changes. The LADIS (Leukoaraiosis and Disability in the Elderly Study). Cerebrovasc Dis 21:315–322CrossRefPubMed Basile AM, Pantoni L, Pracucci G, Asplund K, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, O’Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D (2006) Age, hypertension, and lacunar stroke are the major determinants of the severity of age-related white matter changes. The LADIS (Leukoaraiosis and Disability in the Elderly Study). Cerebrovasc Dis 21:315–322CrossRefPubMed
5.
Zurück zum Zitat Bassetti C, Aldrich MS (1999) Sleep apnea in acute cerebrovascular disease: final report in 128 patients. Sleep 22:217–223PubMed Bassetti C, Aldrich MS (1999) Sleep apnea in acute cerebrovascular disease: final report in 128 patients. Sleep 22:217–223PubMed
6.
Zurück zum Zitat Bassetti CL, Milanova M, Gugger M (2006) Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke 37:967–972CrossRefPubMed Bassetti CL, Milanova M, Gugger M (2006) Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke 37:967–972CrossRefPubMed
7.
Zurück zum Zitat Chaudhary BA, Elguindi AS, King DW (1982) Obstructive sleep apnea after lateral medullary syndrome. South Med J 75:65–67PubMed Chaudhary BA, Elguindi AS, King DW (1982) Obstructive sleep apnea after lateral medullary syndrome. South Med J 75:65–67PubMed
8.
Zurück zum Zitat Cherniack NS, Longobardo G, Evangelista CJ (2005) Causes of Cheyne-Stokes respiration. Neurocrit Care 3:271–279CrossRefPubMed Cherniack NS, Longobardo G, Evangelista CJ (2005) Causes of Cheyne-Stokes respiration. Neurocrit Care 3:271–279CrossRefPubMed
9.
Zurück zum Zitat Durán J, Esnaola S, Rubio R, Iztueta A (2001) Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 163:685–689PubMed Durán J, Esnaola S, Rubio R, Iztueta A (2001) Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 163:685–689PubMed
10.
Zurück zum Zitat Dyken ME, Somers VK, Yamada T, Ren ZY, Zimmerman MB (1996) Investigating the relationship between stroke and obstructive sleep apnea. Stroke 27:401–407PubMed Dyken ME, Somers VK, Yamada T, Ren ZY, Zimmerman MB (1996) Investigating the relationship between stroke and obstructive sleep apnea. Stroke 27:401–407PubMed
11.
Zurück zum Zitat Gandolfo C, Caponnetto C, Del Sette M, Santoloci D, Loeb C (1988) Risk factors in lacunar síndromes: a case-control study. Acta Neurol Scand 77:22–26CrossRefPubMed Gandolfo C, Caponnetto C, Del Sette M, Santoloci D, Loeb C (1988) Risk factors in lacunar síndromes: a case-control study. Acta Neurol Scand 77:22–26CrossRefPubMed
12.
Zurück zum Zitat Harbison J, Gibson GJ, Birchall D, Zammit-Maempel I, Ford GA (2003) White matter disease and sleep-disordered breathing after acute stroke. Neurology 61:959–963PubMed Harbison J, Gibson GJ, Birchall D, Zammit-Maempel I, Ford GA (2003) White matter disease and sleep-disordered breathing after acute stroke. Neurology 61:959–963PubMed
13.
Zurück zum Zitat Harbison JA, James OFW, Gibson GJ, Ford GA (2000) Sleep apnea following stroke. Cerebrovasc Dis 10(Suppl 2):7 Harbison JA, James OFW, Gibson GJ, Ford GA (2000) Sleep apnea following stroke. Cerebrovasc Dis 10(Suppl 2):7
14.
Zurück zum Zitat Hermann DM, Siccoli M, Kirov P, Gugger M, Bassetti CL (2007) Central periodic breathing during sleep in acute ischemic stroke. Stroke 38:1082–1084CrossRefPubMed Hermann DM, Siccoli M, Kirov P, Gugger M, Bassetti CL (2007) Central periodic breathing during sleep in acute ischemic stroke. Stroke 38:1082–1084CrossRefPubMed
15.
Zurück zum Zitat Hudgel DW, Deradtta P, Hamilton H (1993) Pattern of breathing and upper airway mechanics during wakefulness and sleep in healthy elderly humans. J Appl Physiol 74:2198–2204PubMed Hudgel DW, Deradtta P, Hamilton H (1993) Pattern of breathing and upper airway mechanics during wakefulness and sleep in healthy elderly humans. J Appl Physiol 74:2198–2204PubMed
16.
Zurück zum Zitat Hui D, Choy D, Wong L, Ko F, Li T, Woo J, Kay R (2002) Prevalence of sleep-disordered breathing and continuous positive airway pressure compliance. Chest 122:852–860CrossRefPubMed Hui D, Choy D, Wong L, Ko F, Li T, Woo J, Kay R (2002) Prevalence of sleep-disordered breathing and continuous positive airway pressure compliance. Chest 122:852–860CrossRefPubMed
17.
Zurück zum Zitat Jackson C, Sudlow C (2005) Are lacunar strokes really different? A systematic review of differences in risk factor profiles between lacunar and nonlacunar infarcts. Stroke 36:891–904CrossRefPubMed Jackson C, Sudlow C (2005) Are lacunar strokes really different? A systematic review of differences in risk factor profiles between lacunar and nonlacunar infarcts. Stroke 36:891–904CrossRefPubMed
18.
Zurück zum Zitat Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545PubMed Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545PubMed
19.
Zurück zum Zitat Kapen S, Park A, Goldberg J, Whynter J (1991) The incidence and severity of obstructive sleep apnea in ischaemic cerebrovascular disease. Neurology 41(Suppl 1):125 Kapen S, Park A, Goldberg J, Whynter J (1991) The incidence and severity of obstructive sleep apnea in ischaemic cerebrovascular disease. Neurology 41(Suppl 1):125
20.
Zurück zum Zitat Kokturk O, Ciftci TU, Mollarecep E, Ciftci B (2006) Serum homocysteine levels and cardiovascular morbidity in obstructive sleep apnea syndrome. Respir Med 100:536–541CrossRefPubMed Kokturk O, Ciftci TU, Mollarecep E, Ciftci B (2006) Serum homocysteine levels and cardiovascular morbidity in obstructive sleep apnea syndrome. Respir Med 100:536–541CrossRefPubMed
21.
Zurück zum Zitat Laloux P, Jamart J, Meurisse H, De Coster P, Laterre C (1996) Persisting perfusion deficit in transient ischaemic attacks: a new clinical useful group? Stroke 27:425–430PubMed Laloux P, Jamart J, Meurisse H, De Coster P, Laterre C (1996) Persisting perfusion deficit in transient ischaemic attacks: a new clinical useful group? Stroke 27:425–430PubMed
22.
Zurück zum Zitat Lavie L, Lavie P (2008) Smoking interacts with sleep apnea to increase cardiovascular risk. Sleep Med 9:247–253CrossRefPubMed Lavie L, Lavie P (2008) Smoking interacts with sleep apnea to increase cardiovascular risk. Sleep Med 9:247–253CrossRefPubMed
23.
Zurück zum Zitat Lie C, Hirsch JG, Roßmanith C, Hennerici MG, Gass A (2004) Clinicotopographical correlation of corticospinal tract stroke: a color-coded diffusion tensor imaging study. Stroke 35:86–93CrossRefPubMed Lie C, Hirsch JG, Roßmanith C, Hennerici MG, Gass A (2004) Clinicotopographical correlation of corticospinal tract stroke: a color-coded diffusion tensor imaging study. Stroke 35:86–93CrossRefPubMed
24.
Zurück zum Zitat Liepert J, Restemeyer C, Kucinski T, Zittel S, Weiller C (2005) Motor strokes: the lesion location determines motor excitability changes. Stroke 36:2648–2653CrossRefPubMed Liepert J, Restemeyer C, Kucinski T, Zittel S, Weiller C (2005) Motor strokes: the lesion location determines motor excitability changes. Stroke 36:2648–2653CrossRefPubMed
25.
Zurück zum Zitat Lodder J, Bamford JM, Sandercock PAG, Jones LN, Warlow CP (1990) Are hypertension or cardiac embolism likely causes of lacunar infarction? Stroke 21:375–381PubMed Lodder J, Bamford JM, Sandercock PAG, Jones LN, Warlow CP (1990) Are hypertension or cardiac embolism likely causes of lacunar infarction? Stroke 21:375–381PubMed
26.
Zurück zum Zitat Marín JM, Carrizo S, Vicente E, Agustí AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnea-hypoapnea with or without treatment with continuous positive airway pressure: an observational study. Lancet 172:1447–1451 Marín JM, Carrizo S, Vicente E, Agustí AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnea-hypoapnea with or without treatment with continuous positive airway pressure: an observational study. Lancet 172:1447–1451
27.
Zurück zum Zitat Martí-Vilalta JL, Arboix A, Mohr JP (2004) Lacunes. In: Mohr JP, Choi DW, Grotta JC, Weir B, Wolf PhA (eds) Stroke. Pathophysiology, diagnosis, and management. Churchill Livingstone, Philadelphia, pp 275–299 Martí-Vilalta JL, Arboix A, Mohr JP (2004) Lacunes. In: Mohr JP, Choi DW, Grotta JC, Weir B, Wolf PhA (eds) Stroke. Pathophysiology, diagnosis, and management. Churchill Livingstone, Philadelphia, pp 275–299
28.
Zurück zum Zitat Martinez-Garcia MA, Galiano-Blancart R, Soler-Cataluna JJ, Cabero-Salt L, Roman-Sanchez P (2006) Improvement in nocturnal disordered breathing after first-ever ischemic stroke: role of dysphagia. Chest 129:238–245CrossRefPubMed Martinez-Garcia MA, Galiano-Blancart R, Soler-Cataluna JJ, Cabero-Salt L, Roman-Sanchez P (2006) Improvement in nocturnal disordered breathing after first-ever ischemic stroke: role of dysphagia. Chest 129:238–245CrossRefPubMed
29.
Zurück zum Zitat Muñoz R, Duran-Cantolla J, Martinez-Vila E, Gallego J, Rubio R, Aizpuru F, De La Torre G (2006) Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke 37:2317–2321CrossRefPubMed Muñoz R, Duran-Cantolla J, Martinez-Vila E, Gallego J, Rubio R, Aizpuru F, De La Torre G (2006) Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke 37:2317–2321CrossRefPubMed
30.
Zurück zum Zitat Nachtmann A, Siebler M, Rose G, Sitzer M, Teimetz H (1995) Cheyne-Stokes respiration in ischemic stroke. Neurology 45:820–821PubMed Nachtmann A, Siebler M, Rose G, Sitzer M, Teimetz H (1995) Cheyne-Stokes respiration in ischemic stroke. Neurology 45:820–821PubMed
31.
Zurück zum Zitat Netzer N, Werner P, Jochums I, Lehmann M, Strohl K (1998) Blood flow of the middle cerebral artery with sleep-disordered breathing. Stroke 29:87–93PubMed Netzer N, Werner P, Jochums I, Lehmann M, Strohl K (1998) Blood flow of the middle cerebral artery with sleep-disordered breathing. Stroke 29:87–93PubMed
32.
Zurück zum Zitat Nopmaneejumruslers C, Kaneko Y, Hajek V, Zivanovic V, Bradley TD (2005) Cheyne-Stokes respiration in stroke: relationship to hypocapnia and occult cardiac dysfunction. Am J Respir Crit Care Med 171:1048–1052CrossRefPubMed Nopmaneejumruslers C, Kaneko Y, Hajek V, Zivanovic V, Bradley TD (2005) Cheyne-Stokes respiration in stroke: relationship to hypocapnia and occult cardiac dysfunction. Am J Respir Crit Care Med 171:1048–1052CrossRefPubMed
33.
Zurück zum Zitat Norrving B, Staaf G (1991) Pure motor stroke from presumed lacunar infarct. Incidence, risk factors and initial course. Cerebrovasc Dis 1:203–209CrossRef Norrving B, Staaf G (1991) Pure motor stroke from presumed lacunar infarct. Incidence, risk factors and initial course. Cerebrovasc Dis 1:203–209CrossRef
34.
Zurück zum Zitat Parra O (2004) Trastornos respiratorios del sueño y enfermedad vascular cerebral. Arch Bronconeumol 40:34–38 Parra O (2004) Trastornos respiratorios del sueño y enfermedad vascular cerebral. Arch Bronconeumol 40:34–38
35.
Zurück zum Zitat Parra O, Arboix A, Bechich S, Garcia-Eroles Monserrat JM, López JA, Ballester E, Guerra JM, Sopeña JJ (2000) Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med 161:375–380PubMed Parra O, Arboix A, Bechich S, Garcia-Eroles Monserrat JM, López JA, Ballester E, Guerra JM, Sopeña JJ (2000) Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med 161:375–380PubMed
36.
Zurück zum Zitat Parra O, Arboix A, Montserrat JM, Quinto L, Bechich S, Garcia-Eroles L (2004) Sleep-related breathing disorders: impact on mortality of cerebrovascular disease. Eur Respir J 24:267–272CrossRefPubMed Parra O, Arboix A, Montserrat JM, Quinto L, Bechich S, Garcia-Eroles L (2004) Sleep-related breathing disorders: impact on mortality of cerebrovascular disease. Eur Respir J 24:267–272CrossRefPubMed
37.
Zurück zum Zitat Rowat AM, Dennis MS, Wardlaw JM (2006) Central periodic breathing observed on hospital admission is associated with an adverse prognosis in conscious acute stroke patients. Cerebrovasc Dis 21:340–347CrossRefPubMed Rowat AM, Dennis MS, Wardlaw JM (2006) Central periodic breathing observed on hospital admission is associated with an adverse prognosis in conscious acute stroke patients. Cerebrovasc Dis 21:340–347CrossRefPubMed
38.
Zurück zum Zitat Rowat AM, Wardlow JM, Dennis MS (2007) Abnormal breathing patterns in stroke—relationship to acute stroke lesion location and prior cerebrovascular disease. J Neurol Neurosurg Psychiatry 78:277–279CrossRefPubMed Rowat AM, Wardlow JM, Dennis MS (2007) Abnormal breathing patterns in stroke—relationship to acute stroke lesion location and prior cerebrovascular disease. J Neurol Neurosurg Psychiatry 78:277–279CrossRefPubMed
39.
Zurück zum Zitat Sahlin C, Sandberg O, Gustafson Y, Bucht G, Carlberg B, Stenlund H, Franklin KA (2008) Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Int Med 168:297–301CrossRef Sahlin C, Sandberg O, Gustafson Y, Bucht G, Carlberg B, Stenlund H, Franklin KA (2008) Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Int Med 168:297–301CrossRef
40.
Zurück zum Zitat Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, O’Connor GT, Boland LL, Schwartz JE, Samet JM (2001) Sleep-disordered breathing and cardiovascular disease. Cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25PubMed Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, O’Connor GT, Boland LL, Schwartz JE, Samet JM (2001) Sleep-disordered breathing and cardiovascular disease. Cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25PubMed
41.
Zurück zum Zitat Sommers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T (2008) Sleep apnea and cardiovascular disease. Circulation 118:1080–1111CrossRef Sommers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T (2008) Sleep apnea and cardiovascular disease. Circulation 118:1080–1111CrossRef
42.
Zurück zum Zitat Underner M, Paquereau J, Meurice JC (2006) Tabagisme et troubles du sommeil. Rev Mal Respir 23:6S67–6S77PubMed Underner M, Paquereau J, Meurice JC (2006) Tabagisme et troubles du sommeil. Rev Mal Respir 23:6S67–6S77PubMed
43.
Zurück zum Zitat Van Swieten JC, Koudstaal PJ, Visser MC, Schoute HJA, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607PubMed Van Swieten JC, Koudstaal PJ, Visser MC, Schoute HJA, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607PubMed
44.
45.
Zurück zum Zitat Wessendorf TE, Teschler H, Wang YM, Konietzko N, Thilmann AF (2000) Sleep disordered breathing among patients with first-ever stroke. J Neurol 247:41–47CrossRefPubMed Wessendorf TE, Teschler H, Wang YM, Konietzko N, Thilmann AF (2000) Sleep disordered breathing among patients with first-ever stroke. J Neurol 247:41–47CrossRefPubMed
46.
Zurück zum Zitat Wessendorf TE, Thilmann AF, Wang YM, Schreiber A, Konietzko N, Teschler H (2000) Fibrinogen levels and obstructive sleep apnea in ischaemic stroke. Am J Respir Crit Care Med 162:2039–2042PubMed Wessendorf TE, Thilmann AF, Wang YM, Schreiber A, Konietzko N, Teschler H (2000) Fibrinogen levels and obstructive sleep apnea in ischaemic stroke. Am J Respir Crit Care Med 162:2039–2042PubMed
47.
Zurück zum Zitat Yaggi H, Mohsenin V (2003) Sleep-disordered breathing and stroke. Clin Chest Med 24:223–237CrossRefPubMed Yaggi H, Mohsenin V (2003) Sleep-disordered breathing and stroke. Clin Chest Med 24:223–237CrossRefPubMed
48.
Zurück zum Zitat Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353:2034–2041CrossRefPubMed Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353:2034–2041CrossRefPubMed
49.
Zurück zum Zitat You R, McNeil JJ, O’Malley HM, Davis SM, Donnan JA (1995) Risk factors for lacunar infarction syndromes. Neurology 45:1483–1487PubMed You R, McNeil JJ, O’Malley HM, Davis SM, Donnan JA (1995) Risk factors for lacunar infarction syndromes. Neurology 45:1483–1487PubMed
Metadaten
Titel
Sleep-related breathing disorders in acute lacunar stroke
verfasst von
Marc Bonnin-Vilaplana
Adrià Arboix
Olga Parra
Luis García-Eroles
Josep M. Montserrat
Joan Massons
Publikationsdatum
01.12.2009
Verlag
D. Steinkopff-Verlag
Erschienen in
Journal of Neurology / Ausgabe 12/2009
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-009-5236-x

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