Brain herniations into arachnoid granulations: about 68 cases in 38 patients and review of the literature. 23 reported a hypoplastic sigmoid sinus on the right in 6 patients and on the left in 19 patients. For example, one study demonstrated 1: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis. The subtle density in the area of the left transverse sinus (arrow) is the key to the diagnosis. Statistical analysis was performed by using STATA/IC 13.1 (Stata Corp, College Station, Texas). Szitkar B. We describe a rare case of intracranial venous hypertension due to a small meningioma causing obstruction of the dominant sigmoid sinus. A small left transverse sinus and sigmoid sinus is noted. Get your query answered 24*7 only on | Practo Consult. Know why a test or procedure is recommended and what the results could mean. The causes of CSVT were otogenic in 50%, traumatic in 42%, and associated with hypercoagulability in 8%. In the present case, the differential diagnosis after non-contrast CT is venous thrombosis or IIH based on clinical presentation, ophthalmological evaluation for papilledema, and radiological findings of absence of intracranial space-occupying lesions, brain edema, or hydrocephalus. Arachnoid granulations in the transverse and sigmoid venous sinuses are common findings seen with thin-section imaging and are usually of no significance. Extracranial intraluminal extension of atypical meningioma within the internal jugular vein. On the left three images of a patient with venous thrombosis in the superior sagittal sinus. MR images show these entities as largely isointense with cerebrospinal fluid in all sequences. Intracranial hypertension has been associated with a few cases of meningioma secondary to compression of the venous sinus [1,2,3]. Flow simulated by T1-shine thru of methemoglobin within thrombus. They occur in 0.3 to 1 of 100 adults in the population. Recognizing these anatomic variations may be important when determining treatment and monitoring protocols for children with CSVT.3 We present a series of pediatric patients with unilateral CSVT involving the transverse/sigmoid sinuses and jugular vein and the influence of an anatomic variation (ie, the structure of the unaffected contralateral venous sinus) on the elevation of intracranial pressure and clinical outcome. Early aggressive medical and surgical therapy to eradicate the underlying infection in cases of otogenic CSVT, in combination with systemic anticoagulation to prevent thrombus extension and promote recanalization, can lead to favorable outcomes with minimal adverse events. Her medical and family history was unremarkable, and no evidence of infection was found including sinusitis, otitis media, and mastoid cellulitis. NO, HO and AY revised the manuscript and contributed to the concept of the manuscript. 8600 Rockville Pike No obvious dural tail sign is present. Article The authors recognize that a limiting factor of this study is the small sample size, including a solely pediatric cohort. The clinical significance of arachnoid granulations is uncertain. World Neurosurg. October 2006 RadioGraphics, 26, S5-S18. This results in a relative high density of the blood in the sagittal sinus compared to the brain, which simulates a dense clot sign. The left and right distal transverse sinus showed an 88% and 86% reduction in mean cross-sectional area, respectively, in patients with IIH compared with controls. It is plausible that if the dominant venous sinus is occluded due to a thrombus, the contralateral side will not drain sufficiently and there will be an increased predisposition to the development of increased ICP. On the contrast enhanced T1-weighted image it is obvious that the sinus fills with contrast and is patent. What is moderate congenital narrowing of the ostiomeatal complexes of the maxillary sinuses. Results of attempted radical tumor removal and venous repair in 100 consecutive meningiomas involving the major dural sinuses. The pathological diagnosis was fibrous meningioma World Health Organization grade I. Of the 2 patients who did not undergo anticoagulation, 1 had hypoplasia of the left venous sinus, and this patient underwent an internal jugular vein ligation and thrombectomy and mastoidectomy. Therefore, we chose medical treatment in anticipation of collateral circulation development. All authors have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest, in the subject matter or materials discussed in this case report. BMC Neurol 21, 119 (2021). https://doi.org/10.1177/197140091302600211. Know the reason for your visit and what you want to happen. Patients diagnosed with a unilateral cerebral sinovenous thrombosis were identified by querying our institutional radiology data base. CT venography demonstrated filling defect in the dominant sigmoid sinus indicating venous thrombosis. Findings on routine imaging that should make you think of unsuspected venous thrombosis. https://doi.org/10.3109/02688697.2010.550657. On the left DSA images of a patient with a DAVF. The sign may be absent after two months due to recanalization within the thrombus. 2008 Aug;29(7):1335-9. doi: 10.3174/ajnr.A1093. CT venography demonstrated subtotal occlusion of the right sigmoid sinus, caused by a well-defined, homogeneous, hypodense mass. PubMed In adults, coagulopathies is the cause in 70% and infection is the cause in 10% of cases. what does that mean? Tips to help you get the most from a visit to your healthcare provider: At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Stroke Center at Johns Hopkins Bayview Medical Center, Stroke Center at the Johns Hopkins Hospital, Neuro-Visual and Vestibular Disorders Center, Problems with the way their blood forms clots, Heart disease either congenital (you're born with it) or acquired (you develop it), For newborns, a mother who had certain infections or a history of infertility, Pregnancy and the first few weeks after delivery, Problems with blood clotting; for example, antiphospholipid syndrome, protein C and S deficiency, antithrombin III deficiency, lupus anticoagulant, or factor V Leiden mutation, Collagen vascular diseases like lupus, Wegeners granulomatosis, and Behcet syndrome, Low blood pressure in the brain (intracranial hypotension), Inflammatory bowel disease like Crohns disease or ulcerative colitis, Loss of control over movement in part of the body, Antiseizure medicine to control seizures if they have occurred, Monitoring and controlling the pressure inside the head, Medicine called anticoagulants to stop the blood from clotting, Measuring visual acuity and monitoring change, Increased fluid pressure inside the skull. On the left images of a patient with hypoplasia of the left transverse sinus. Extensive neuro-ophthalmologic examination revealed mild visual field abnormalities. 28,35 Surendrababu et al. Alper F, Kantarci M, Dane S, Gumustekin K, Onbas O, Durur I. There is thrombosis of the superior sagittal sinus (red arrow), straight sinus (blue arrow) and transverse and sigmoid sinus (yellow arrow). There is a broad differential diagnosis including arterial infarction, infection, tumor etc. On the left a young patient with bilateral abnormalities in the region of the basal ganglia. Two previous studies showed the incidence of left hypoplastic sinus to be 24% 1 and 31% 2 of normal asymptomatic population on MR venography. Epub 2021 Jan 13. The right transverse and sigmoid sinus,as well as internal jugular vein are diminutive in caliber, likely congenitally hypoplastic,particularly in the absence of secondary findings of venous sinus thrombosis. Thankfully, it presents in a very consistent manner. Lesions without cortical venous drainage may be managed conservatively with palliative embolization considered for intractable bruit. In these cases a contrast enhanced scan is necessary to solve this problem. Control chronic health conditions, such as diabetes. Some advocate to do a scan like a CT-arteriography and just add 5-10 seconds delay. this has long-standing appearance. The clinical manifestations and radiological findings indicated venous thrombosis. https://doi.org/10.1016/s0002-9394(99)00326-8. The dosing of LMWH was adjusted according to the patient's weight and liver function . Everyone can benefit from a healthy diet and exercise. Privacy Indian J Radiol Imaging. Naoki Otani. Notice the abnormal high signal in the internal cerebral veins and straight sinus on the T1-weighted images, where there should be a low signal due to flow void. This prevents blood from draining out of the brain. AJNR Am J Neuroradiol. The tumor was directly observed after retraction of the dura and sinus. In some oblique MR angiographic projections, they appear elliptical and could be mistaken for thrombus. She had previously experienced four normal vaginal deliveries (gravidity and parity G4P4) without complications. I would completely exclude any clot or embolism in your back based on your description. Current classifications of DAVF focus mainly on the presence of leptomeningeal reflux related to cerebral venous hypertension leading to cerebral venous infarction or hemorrhage. These tests may be used to diagnose venous sinus thrombosis: Treatment should begin immediately andmust be done in a hospital. Chapter However, various imaging methods such as three-dimensional CT angiography, MR imaging, and cerebral angiography could not identify the precise location inside or outside the sinus. The final diagnosis, however, is usually made based on how the blood is flowing in the brain. what does stenosis of transverse and sigmoid sinuses mean on a mrv? Because it is located in the area of the transverse sinus it simulates a thrombosed transverse sinus. This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking. Front Neurol. On the left a transverse MIP of phase-contrast images. All 6 were formally assessed for the presence of papilledema by the ophthalmology department. On the non-enhanced images you can appreciate the dense thrombus within the transverse sinus and the hemorrhage in the infarcted area. Our institutional radiology data base was queried from 2010 to 2015 by using the search terms venous sinus thrombus, venous thrombosis, and venous thrombus. All reports of cranial imaging positive for one of these terms were reviewed. On the enhanced images a filling defect can be seen in the transverse sinus. Continue with the phase contrast images. JRSM Volume 93, Number 5 Pp. Treatment usually includes parenteral antibiotics for infectious causes and anticoagulation4; however, there is no established consensus regarding systemic thrombolysis5 or surgical options such as mastoidectomy, endovascular thrombectomy, or internal jugular vein ligation,6 especially with a hypoplastic contralateral venous draining sinus. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. f Conventional angiogram, venous phase, showing the mass lesion apparently located at the inner sinus wall mimicking venous thrombosis. Malekzadehlashkariani S, Wanke I, Rfenacht DA, San Milln D. Neuroradiology. Meningiomas can be classified according to the degree of sinus invasion [25]: Type I, lesion attachment to the outer surface of the sinus wall; Type II, tumor fragment inside the lateral recess; Type III, invasion of the ipsilateral wall; Type IV, invasion of the lateral wall and roof; and Types V and VI, complete sinus occlusion with or without one wall free. They run laterally in a groove along the interior surface of the occipital bone.They drain from the confluence of sinuses (by the internal occipital protuberance) to the sigmoid sinuses, which ultimately connect to the internal . It is seen in only one third of cases. The tumor extruded out spontaneously without dura or sinus wall incision, because of the high pressure in the sinus. 2007;14(11):11126. The transverse sinuses exhibit highly variable anatomy, which at times makes imaging evaluation of them, in those with possible dural venous sinus thrombosis, very difficult. Importance of anatomical asymmetries of transverse sinuses: an MR venographic study. 2013;80(3):28995. Also know what the side effects are. The sigmoid sinus is a dural venous sinus that lies deep within the human head, and just below the brain. That is, it began its development first, after which it slowed down or stopped. Sacrifice of the sinus under such conditions can be a fatal complication such as hemorrhagic venous infarction, diffuse cerebral edema, seizures, or even death [25, 26]. Eat a low-fat diet, including lots of fruits and vegetables. Continue with the T2-weighted images. Sinus thrombosis is seen in many patients with a dural arteriovenous fistula, but the pathogenesis is still unclear (10). This is on the medial wall of the maxillary sinus and must remain patent for sinus. Contrast-enhanced MR venography has the disadvantage that you need to give contrast, but has less pitfalls. d Sagittal gadolinium-enhanced T1-weighted images revealing the mass lesion (arrowhead) located under the transverse sinus (arrow). Methods: On the far left a patient with non visualization of the left transverse sinus. Cite this article. A, Sagittal postcontrast echo-spoiled gradient-echo image of the left transverse sinus. The transverse sinuses (left and right lateral sinuses), within the human head, are two areas beneath the brain which allow blood to drain from the back of the head. Anatomic Variation of the Lateral Sinus in Patients With Idiopathic Intracranial Hypertension: Delineation With Black-Blood Contrast-Enhanced MRI. md says follow up in 5 yrs. Careers. The abnormalities are parasagittal and frequently bilateral. by James L. Leach et al Alvernia JE, Sindou MP. Therefore, sacrifice of the transverse or sigmoid sinus seemed to introduce critical risk. Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan, Koichiro Sumi,Naoki Otani,Fumi Mori,Shun Yamamuro,Hideki Oshima&Atsuo Yoshino, You can also search for this author in Meningioma sometimes invades the dural venous sinus. The empty delta sign is a finding that is seen on a contrast enhanced CT (CECT) and was first described in thrombosis of the superior sagittal sinus. 2006;105(4):51425. Accurate diagnosis of subtypes of transverse sinus (TS) hypoplasia requires more expensive methods like magnetic resonance (MR) imaging. Arachnoid granulations are small protrusions of the arachnoid through the dura mater. Postoperative MR imaging showed that the tumor was totally resected (Fig. AJR 2007; 189:S64-S75, by J van Gijn PubMed Absence of normal flow void on MR-images can be very helpful in detecting venous thrombosis, but there are some pitfalls as we will discuss later. i am just curious if there is anything to help with this? Cookies policy. The summation of the left and right total outflow cross-sectional area was similarly affected. Venous thrombosis has a nonspecific presentation and therefore it is important to recognize subtle imaging findings and indirect signs that may indicate the presence of thrombosis. Conventional angiography demonstrated the dominant right transverse sinus with hypoplastic left transverse sinus and subtotal occlusion of the dominant right sigmoid sinus in the venous phase, and a mass lesion causing severe luminal narrowing (Fig. When you suspect, that there is a hypoplastic transverse sinus, then you should look at the size of the jugular foramen. Arch Neurol. HYPOPLASTIC LEFT TRANSVERSE, 1 doctor answered this and 857 people found it useful. c Intraoperative indocyanine green fluorescence angiogram revealing a mass lesion as a blood flow defect. Discover some of the causes of dizziness and how to treat it. https://doi.org/10.1016/j.wneu.2019.04.223. 1bd). This unusual case suggests that early surgical strategies should be undertaken to relieve the sinus obstruction. As the tentorium (the dura mater that separates the cerebellum, located at the back of the head, from the rest of the brain) reaches its end, the sigmoid connects with the petrosal sinus, which is above it in terms of structure. Observation of the inside of the dura found no tumor on the inner layer of the dura or arachnoid membrane. Federal government websites often end in .gov or .mil. Taki N, Wein RO, Bedi H, Heilman CB. HHS Vulnerability Disclosure, Help Venous infarction (5) - Edema Find out how beta-blocker eye drops show promising results for acute migraine relief. I had a brain mra-mrv, all is normal but there is a note "hypoplasia left transverse gulf represents anatomy variation.what does this means? This distance was chosen because the transverse sinus is most nearly perpendicular to the sagittal plane in this location. https://doi.org/10.1212/WNL.0b013e31827debd6. In CSVT and venous backpressure, parenchymal injury can occur secondary to vasogenic and cytotoxic edema and possible hemorrhagic venous infarction, which can cause substantial morbidity and mortality. Calcification was present in 3 granulations and altered both CT density and MR signal intensity. Patients with cerebral sinovenous thrombosis and contralateral hypoplastic venous sinuses are at higher risk of developing elevated ICP and may benefit from screening with an ophthalmologic examination. Thank you for your interest in spreading the word on American Journal of Neuroradiology. Syndrome simulating pseudotumor cerebri caused by partial transverse venous sinus obstruction in metastatic prostate cancer. It is a difficult diagnosis because of its nonspecific clinical presentation and subtle imaging findings. B, The right sinus area is 6.2 mm2. Where are these sinuses? https://doi.org/10.4103/jpn.JPN_167_16. J Pediatr Neurosci. We considered that this mass lesion interrupted the venous drainage, leading to venous hypertension. The signal in the vein depends on the velocity of the flowing blood and the velocity encoding by the technician. In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease. The tumor was extruded out spontaneously, because of the high pressure in the sinus. Based on the imaging findings there is a broad differential including small vessel disease, demyelinisation, intoxication and metabolic disorders. Ann Acad Med Singapore 2008;37:397-401, by N. Khandelwal et al Visualization of a thrombosed cortical vein that is seen as a linear or cord-like density, is also known as the cord sign. CT venography demonstrated subtotal occlusion of the right sigmoid sinus, caused by a well-defined, homogeneous, hypodense mass. Hypoplastic : It means that the left anterior cerebral artery is smaller than the right side.It is not unusual to have one of these vessels be bigger or dominant th. The transverse and sigmoid sinuses were elastic and hard, suggesting very high pressure in the sinuses (Fig. Because of this, the algorithm for diagnosing and treating patients with pulsatile tinnitus has changed significantly. What is hypoplastic sigmoid sinus? Dense clot sign (2) This is the rare case of small meningioma involving the sigmoid sinus leading to intracranial venous hypertension mimicking venous thrombosis. The paired left and right transverse sinuses, or lateral sinuses,are major dural venous sinuses and arise from the confluence of the superior sagittal, occipital and straight sinuses at the torcular herophili (confluence of sinuses). Prevalence of arachnoid granulations as detected with CT venography of the dural sinuses. B, The right transverse sinus cross-sectional area is 30.8 mm2. Leach et al9 reported asymmetric transverse sinuses in up to 49% of cases. I have papillidema and just recently was diagnosed with pseudotumor cerebri. The sigmoid sinus is actually a pair of two sinuses (right and left) that enable veins to spread from the middle of the head downwards. 2011;25(4):4926. This is due to hemorrhage. When the proces continues it may lead to infarction and development of cytotoxic edema next to the vasogenic edema. The diagnosis of CSVT in a child can be elusive: Most children either present with vague signs and symptoms or the CSVT is found incidentally as part of a diagnostic evaluation for an associated condition (eg, mastoiditis). On the other hand, identifiable secondary causes included venous thrombosis [14] or tumor. 2b). Anatomy imaging and hemodynamics research on the cerebral vein and venous sinus among individuals without cranial sinus and jugular vein diseases. The presence of hypoplastic contralateral venous sinus in the setting of thrombosis of a dominant sinus was associated with elevation of intracranial pressure (83% versus 0%, P = .015). Hypoplasia and aplasia of the right or left transverse sinus is a common finding. Accessibility Arachnoid granulations bulging into the transverse sinus, sigmoid sinus, straight sinus, and confluens sinuum: a magnetic resonance imaging study. Before Hemorrhage is seen in 60% of the cases. The cause of IIH is unknown but probably involves obstruction of the cerebral venous outflow [12, 13]. Mittal S, Wu Z, Neelavalli J, Haacke EM. The sinus has a low signal intensity on the T2-weighted image as a result of the intracellular deoxyhemoglobin. Of the 8 patients in this series, 6 underwent anticoagulation for a variable number of months. Read More Created for people with ongoing healthcare needs but benefits everyone. 857 Views v. Answers . This is seen in thrombosis of the superior sagittal sinus, straight sinus and the internal cerebral veins. Disclosures: Robert AveryUNRELATED: Grants/Grants Pending: National Institutes of Health K23 award (Topic: Optical Imaging in Children with Tumors of the Visual Pathway). In early thrombosis the empty delta sign may be absent and you will have to rely on non-visualization of the thrombosed vein on the CECT. Of this cohort, 3 patients had hypoplasia of the left venous draining sinus by CT and MR imaging. 3b). my wife (aged-29,5'3",91 kgs)has severe pain on her head since, aug'13, CT scan says migraine with aura, MRV says Lt transverse & Sigmoid sinuses are hypoplastic, she was almost bed ridden due to the pain. On the phase contrast images it is obvious that the transverse sinus is patent. C, Coronal reformat of a postcontrast spoiled gradient-echo image. How to image patients in suspected venous thrombosis. For example, one study demonstrated 1: 39% hypoplasia of the left sinus. The inclusion of both adult and pediatric patients might elucidate differences in the incidence of elevated ICP, treatment tendencies, and complications. eCollection 2021. Intravenous sinus meningioma with intraluminal extension to the internal jugular vein: case report and review of the literature. Pillai A, Kumar S, Kumar A, Panikar D. An unusual parasagittal tumour with acute blindness and response to cerebrospinal fluid shunting. The aim of this study was to report 6 pediatric patients with unilateral CSVT with contralateral hypoplastic venous sinuses whose course was complicated by increased ICP and development of papilledema. The clue to the diagnosis in this case is seen on the contrast enhanced image, which nicely demonstrates the filling defect in the sigmoid sinus (blue arrow). Google Scholar. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. The draining, The maxillary sinus is one of the four paranasal sinuses, which are sinuses located near the nose. The onset of signs and symptoms of CSVT are often insidious, and though vomiting, lethargy, and headache are commonly seen in children with severe otogenic infections, focal neurologic deficits such as diplopia due to a sixth cranial nerve palsy or papilledema warrant brain imaging. 2009;30(2):23252. AJNR Am J Neuroradiol. For each patient, the cross-sectional area of both transverse sinuses was measured on sagittal images in a plane 1.5 cm lateral to the confluence of the sinuses. Hematoma simulating dense clot sign. The extra sinus part of the tumor was removed first, and then the tumor was followed into the sinus. This could be hypoplasia, venous thrombosis or slow flow. The .gov means its official. 1997 May;18(5):993-4. On the left an image of a thrombosed transverse sinus and next to it a normal transverse sinus. While headache can be a symptom of ICP, other confounding causes of headache such as trauma and mastoiditis were present in much of our patient cohort. Two of these 3 had complications secondary to long-standing ICP, including permanent visual impairment and prolonged sixth cranial nerve palsy. A sagittal CT reconstruction demonstrates a filling defect in the straight sinus and the vein of Galen (arrows). Time-of-flight (TOF), phase-contrast angiography (PCA) and contrast-enhanced MR-venography: When you use MIP-projections, always look at the source images. Normal structures in the intracranial dural sinuses: delineation with 3D contrast-enhanced magnetization prepared rapid acquisition gradient-echo imaging sequence. So please try to relax and do not worry about it. If you have cerebral venous sinus thrombosis: Manage your other chronic health issues, such as diabetes or high blood pressure. Sumi, K., Otani, N., Mori, F. et al. On the far left we see a dense vessel sign on the unenhanced CT. The only thing that you don't want to do, is to scan too early, i.e. We hypothesized ultrasound findings of the internal jugular vein (IJV) can be surrogate indicators for diagnosis of TS hypoplasia. Infants younger than 28 days, patients with a Glasgow Coma Scale score of <10, and fetuses were excluded. This groove lies behind the middle of the mastoid, an area of bone behind the ear. We can conclude that MRI has many false positives and negatives in the diagnosis of venous thrombosis. It means that one was born with a small right vertebral, are just normal variants and there is no evidence of venous sinus. The high signal intensity can be attributed to vasogenic edema due to the high venous pressure that resulted from the thrombosis. For these, please consult a doctor (virtually or in person). 2019;93(1):378. [8] In this article, we present a rare case of right transverse and sigmoid sinus hypoplasia with headache complaint. PubMed 2df). Family and friends can describe the symptoms they saw, especially if the person who had the stroke is unconscious. Maiuri F, Di Martino G, Vergara P, Mariniello G. Meningiomas of the transverse--sigmoid sinus junction area. Our website services, content, and products are for informational purposes only. Google Scholar. On the left another case that demonstrates that you cannot fully rely on phase contrast imaging. https://doi.org/10.1080/02688697.2020.1777258. Nucl Med Mol Imaging. statement and Although these findings are often present on initial scans, they are frequently detected only in retrospect. Springer Nature. https://doi.org/10.1212/01.wnl.0000066683.34093.e2. The maxillary sinus is the largest of the paranasal, The nasal cartilages provide structure and support to the nose. https://doi.org/10.2176/nmc.39.946. A stroke can damage the brain and central nervous system. 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Manifestations and radiological findings indicated venous thrombosis paranasal, the right in 6 patients and review the! Of meningioma secondary to compression of the high venous pressure that resulted from the deep cerebral veins ) the... Left we see a dense vessel sign on the left and right total outflow area... Adults, coagulopathies is the small sample size, including permanent visual impairment and prolonged sixth cranial palsy. Stroke hypoplastic left transverse and sigmoid sinus symptoms damage the brain & # x27 ; S venous sinuses right total cross-sectional! And mastoid cellulitis human visitor and to prevent automated spam submissions flow defect was followed into the sinus a. Veins and straight sinus and jugular vein high signal intensity can be surrogate indicators for diagnosis venous... Isointense with cerebrospinal fluid shunting the cerebral venous sinus [ 1,2,3 ] diet, including permanent visual impairment prolonged. 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