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<meta name="HW.identifier" content="/ajnr/early/2020/10/29/ajnr.A6920.atom" />
<meta name="HW.pisa" content="ajnr;ajnr.A6920v1" />
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<meta name="DC.Language" content="en" />
<meta name="DC.Title" content="COVID-19 Severity and Stroke: Correlation of Imaging and Laboratory Markers" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6920" />
<meta name="DC.Date" content="2020-10-29" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2020 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) appears to be an independent risk factor for stroke. We hypothesize that patients who develop stroke while hospitalized for severe COVID-19 will have higher inflammatory markers and distinct stroke imaging patterns compared with patients positive for COVID-19 with out-of-hospital stroke onset and milder or no COVID-19 symptoms.

MATERIALS AND METHODS: This is a retrospective case series of patients positive for COVID-19 on polymerase chain reaction testing with imaging-confirmed stroke treated within a large health care network in New York City and Long Island between March 14 and April 26, 2020. Clinical and laboratory data collected retrospectively included complete blood counts and creatinine, alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer levels. All CT and MR imaging studies were independently reviewed by 2 neuroradiologists who recorded stroke subtype and patterns of infarction and intracranial hemorrhage.

RESULTS: Compared with patients with COVID-19 with outside-of-hospital stroke onset and milder or no COVID-19 symptoms ( n  = 45, 52.3%), patients with stroke already hospitalized for severe COVID-19 ( n  = 41, 47.7%) had significantly more frequent infarctions (95.1% versus 73.3%, P  = .006), with multivascular distributions (56.4% versus 33.3%, P  = .022) and associated hemorrhage (31.7% versus 4.4%, P  = .001). Patients with stroke admitted with more severe COVID-19 had significantly higher C-reactive protein and ferritin levels, elevated D-dimer levels, and more frequent lymphopenia and renal and hepatic injury (all, P  &lt; .003).

CONCLUSIONS: Patients with stroke hospitalized with severe COVID-19 are characterized by higher inflammatory, coagulopathy, and tissue-damage biomarkers, supporting proposed pathogenic mechanisms of hyperinflammation activating a prothrombotic state. Cautious balancing of thrombosis and the risk of hemorrhagic transformation is warranted when considering anticoagulation.

COVID-19
:   coronavirus disease 2019
SARS-CoV-2
:   Severe Acute Respiratory Syndrome coronavirus 2" />
<meta name="DC.Contributor" content="J.M. Katz" />
<meta name="DC.Contributor" content="R.B. Libman" />
<meta name="DC.Contributor" content="J.J. Wang" />
<meta name="DC.Contributor" content="C.G. Filippi" />
<meta name="DC.Contributor" content="P. Sanelli" />
<meta name="DC.Contributor" content="A. Zlochower" />
<meta name="DC.Contributor" content="M. Gribko" />
<meta name="DC.Contributor" content="S.V. Pacia" />
<meta name="DC.Contributor" content="R.I. Kuzniecky" />
<meta name="DC.Contributor" content="S. Najjar" />
<meta name="DC.Contributor" content="S. Azhar" />
<meta name="article:published_time" content="2020-10-29" />
<meta name="article:section" content="ADULT BRAIN" />
<meta name="citation_title" content="COVID-19 Severity and Stroke: Correlation of Imaging and Laboratory Markers" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Coronavirus disease 2019 (COVID-19) appears to be an independent risk factor for stroke. We hypothesize that patients who develop stroke while hospitalized for severe COVID-19 will have higher inflammatory markers and distinct stroke imaging patterns compared with patients positive for COVID-19 with out-of-hospital stroke onset and milder or no COVID-19 symptoms.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;This is a retrospective case series of patients positive for COVID-19 on polymerase chain reaction testing with imaging-confirmed stroke treated within a large health care network in New York City and Long Island between March 14 and April 26, 2020. Clinical and laboratory data collected retrospectively included complete blood counts and creatinine, alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer levels. All CT and MR imaging studies were independently reviewed by 2 neuroradiologists who recorded stroke subtype and patterns of infarction and intracranial hemorrhage.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Compared with patients with COVID-19 with outside-of-hospital stroke onset and milder or no COVID-19 symptoms (&lt;i&gt;n&lt;/i&gt; = 45, 52.3%), patients with stroke already hospitalized for severe COVID-19 (&lt;i&gt;n&lt;/i&gt; = 41, 47.7%) had significantly more frequent infarctions (95.1% versus 73.3%, &lt;i&gt;P &lt;/i&gt;= .006), with multivascular distributions (56.4% versus 33.3%, &lt;i&gt;P &lt;/i&gt;= .022) and associated hemorrhage (31.7% versus 4.4%, &lt;i&gt;P &lt;/i&gt;= .001). Patients with stroke admitted with more severe COVID-19 had significantly higher C-reactive protein and ferritin levels, elevated D-dimer levels, and more frequent lymphopenia and renal and hepatic injury (all, &lt;i&gt;P &lt;/i&gt;&amp;lt; .003).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Patients with stroke hospitalized with severe COVID-19 are characterized by higher inflammatory, coagulopathy, and tissue-damage biomarkers, supporting proposed pathogenic mechanisms of hyperinflammation activating a prothrombotic state. Cautious balancing of thrombosis and the risk of hemorrhagic transformation is warranted when considering anticoagulation.&lt;/p&gt;" />
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<meta name="twitter:title" content="COVID-19 Severity and Stroke: Correlation of Imaging and Laboratory Markers" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) appears to be an independent risk factor for stroke. We hypothesize that patients who develop stroke while hospitalized for severe COVID-19 will have higher inflammatory markers and distinct stroke imaging patterns compared with patients positive for COVID-19 with out-of-hospital stroke onset and milder or no COVID-19 symptoms.

MATERIALS AND METHODS: This is a retrospective case series of patients positive for COVID-19 on polymerase chain reaction testing with imaging-confirmed stroke treated within a large health care network in New York City and Long Island between March 14 and April 26, 2020. Clinical and laboratory data collected retrospectively included complete blood counts and creatinine, alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer levels. All CT and MR imaging studies were independently reviewed by 2 neuroradiologists who recorded stroke subtype and patterns of infarction and intracranial hemorrhage.

RESULTS: Compared with patients with COVID-19 with outside-of-hospital stroke onset and milder or no COVID-19 symptoms ( n  = 45, 52.3%), patients with stroke already hospitalized for severe COVID-19 ( n  = 41, 47.7%) had significantly more frequent infarctions (95.1% versus 73.3%, P  = .006), with multivascular distributions (56.4% versus 33.3%, P  = .022) and associated hemorrhage (31.7% versus 4.4%, P  = .001). Patients with stroke admitted with more severe COVID-19 had significantly higher C-reactive protein and ferritin levels, elevated D-dimer levels, and more frequent lymphopenia and renal and hepatic injury (all, P  &lt; .003).

CONCLUSIONS: Patients with stroke hospitalized with severe COVID-19 are characterized by higher inflammatory, coagulopathy, and tissue-damage biomarkers, supporting proposed pathogenic mechanisms of hyperinflammation activating a prothrombotic state. Cautious balancing of thrombosis and the risk of hemorrhagic transformation is warranted when considering anticoagulation.

COVID-19
:   coronavirus disease 2019
SARS-CoV-2
:   Severe Acute Respiratory Syndrome coronavirus 2" />
<meta name="og-title" property="og:title" content="COVID-19 Severity and Stroke: Correlation of Imaging and Laboratory Markers" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2020/10/29/ajnr.A6920" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) appears to be an independent risk factor for stroke. We hypothesize that patients who develop stroke while hospitalized for severe COVID-19 will have higher inflammatory markers and distinct stroke imaging patterns compared with patients positive for COVID-19 with out-of-hospital stroke onset and milder or no COVID-19 symptoms.

MATERIALS AND METHODS: This is a retrospective case series of patients positive for COVID-19 on polymerase chain reaction testing with imaging-confirmed stroke treated within a large health care network in New York City and Long Island between March 14 and April 26, 2020. Clinical and laboratory data collected retrospectively included complete blood counts and creatinine, alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer levels. All CT and MR imaging studies were independently reviewed by 2 neuroradiologists who recorded stroke subtype and patterns of infarction and intracranial hemorrhage.

RESULTS: Compared with patients with COVID-19 with outside-of-hospital stroke onset and milder or no COVID-19 symptoms ( n  = 45, 52.3%), patients with stroke already hospitalized for severe COVID-19 ( n  = 41, 47.7%) had significantly more frequent infarctions (95.1% versus 73.3%, P  = .006), with multivascular distributions (56.4% versus 33.3%, P  = .022) and associated hemorrhage (31.7% versus 4.4%, P  = .001). Patients with stroke admitted with more severe COVID-19 had significantly higher C-reactive protein and ferritin levels, elevated D-dimer levels, and more frequent lymphopenia and renal and hepatic injury (all, P  &lt; .003).

CONCLUSIONS: Patients with stroke hospitalized with severe COVID-19 are characterized by higher inflammatory, coagulopathy, and tissue-damage biomarkers, supporting proposed pathogenic mechanisms of hyperinflammation activating a prothrombotic state. Cautious balancing of thrombosis and the risk of hemorrhagic transformation is warranted when considering anticoagulation.

COVID-19
:   coronavirus disease 2019
SARS-CoV-2
:   Severe Acute Respiratory Syndrome coronavirus 2" />
<meta name="og-type" property="og:type" content="article" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node79466--5" data-node-nid="79466" id="top-node-79466--61793566541" data-pisa="ajnr;ajnr.A6920v1" data-pisa-master="ajnr;ajnr.A6920" data-apath="/ajnr/early/2020/10/29/ajnr.A6920.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">ADULT BRAIN</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">COVID-19 Severity and Stroke: Correlation of Imaging and Laboratory Markers</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.M. Katz</span>, <span class="highwire-citation-author" data-delta="1">R.B. Libman</span>, <span class="highwire-citation-author" data-delta="2">J.J. Wang</span>, <span class="highwire-citation-author" data-delta="3">C.G. Filippi</span>, <span class="highwire-citation-author" data-delta="4">P. Sanelli</span>, <span class="highwire-citation-author" data-delta="5">A. Zlochower</span>, <span class="highwire-citation-author" data-delta="6">M. Gribko</span>, <span class="highwire-citation-author" data-delta="7">S.V. Pacia</span>, <span class="highwire-citation-author" data-delta="8">R.I. Kuzniecky</span>, <span class="highwire-citation-author" data-delta="9">S. Najjar</span> and <span class="highwire-citation-author" data-delta="10">S. Azhar</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2020,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6920 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-79466--61793566541" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.M. Katz </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurology (J.M.K., R.B.L., M.G., S.V.P., R.I.K., S.N., S.A.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.M.%2BKatz%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Katz%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.M.%2BKatz%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8193-3683" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.M. Katz</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">R.B. Libman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurology (J.M.K., R.B.L., M.G., S.V.P., R.I.K., S.N., S.A.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.B.%2BLibman%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Libman%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.B.%2BLibman%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3978-7985" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R.B. Libman</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">J.J. Wang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Feinstein Institute for Medical Research at Northwell Health (J.J.W.), Manhasset, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.J.%2BWang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wang%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.J.%2BWang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6211-2572" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.J. Wang</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">C.G. Filippi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Radiology (C.G.F., P.S., A.Z.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.G.%2BFilippi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Filippi%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.G.%2BFilippi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4565-2614" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C.G. Filippi</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">P. Sanelli </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Radiology (C.G.F., P.S., A.Z.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BSanelli%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sanelli%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AP.%2BSanelli%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9633-3699" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P. Sanelli</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">A. Zlochower </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Radiology (C.G.F., P.S., A.Z.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BZlochower%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zlochower%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.%2BZlochower%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4998-180X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Zlochower</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">M. Gribko </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurology (J.M.K., R.B.L., M.G., S.V.P., R.I.K., S.N., S.A.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BGribko%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gribko%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BGribko%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-7950-5014" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Gribko</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">S.V. Pacia </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurology (J.M.K., R.B.L., M.G., S.V.P., R.I.K., S.N., S.A.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.V.%2BPacia%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pacia%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.V.%2BPacia%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4801-3030" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.V. 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Kuzniecky </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurology (J.M.K., R.B.L., M.G., S.V.P., R.I.K., S.N., S.A.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.I.%2BKuzniecky%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kuzniecky%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.I.%2BKuzniecky%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3170-150X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R.I. Kuzniecky</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">S. Najjar </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurology (J.M.K., R.B.L., M.G., S.V.P., R.I.K., S.N., S.A.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BNajjar%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Najjar%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BNajjar%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4701-1503" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Najjar</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">S. Azhar </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurology (J.M.K., R.B.L., M.G., S.V.P., R.I.K., S.N., S.A.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BAzhar%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Azhar%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BAzhar%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3807-2187" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. 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