Hiperintensidades de sustancia blanca en pacientes con migraña

Introducción: Las hiperintensidades de sustancia blanca son cada vez un hallazgo más frecuente en las resonancias magnéticas cerebrales y han sido descritas en numerosas patologías. Su diagnóstico diferencial dependerá de la localización, morfología y comportamiento en el tiempo y en las diferentes...

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Autores:: Rey Ayala, Milena

Tipo de recurso:

Fecha de publicación:: 2022

Institución:: Universidad Autónoma de Bucaramanga - UNAB

Repositorio:: Repositorio UNAB

Idioma:: spa

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dc.title.spa.fl_str_mv	Hiperintensidades de sustancia blanca en pacientes con migraña
dc.title.translated.spa.fl_str_mv	White matter hyperintensities in patients with migraine
title	Hiperintensidades de sustancia blanca en pacientes con migraña
spellingShingle	Hiperintensidades de sustancia blanca en pacientes con migraña Medical sciences Health sciences Radiology Diagnostic imaging White matter hyperintensities Migraine Patient Magnetic resonance imaging Cephalalgia Demographic characteristics Imaging systems in medicine Ciencias médicas Radiología Diagnóstico para imágenes Resonancia magnética Cefalalgia Características demográficas Sistemas de imágenes en medicina Ciencias de la salud Hiperintensidades de sustancia blanca Migraña Paciente
title_short	Hiperintensidades de sustancia blanca en pacientes con migraña
title_full	Hiperintensidades de sustancia blanca en pacientes con migraña
title_fullStr	Hiperintensidades de sustancia blanca en pacientes con migraña
title_full_unstemmed	Hiperintensidades de sustancia blanca en pacientes con migraña
title_sort	Hiperintensidades de sustancia blanca en pacientes con migraña
dc.creator.fl_str_mv	Rey Ayala, Milena
dc.contributor.advisor.none.fl_str_mv	Araújo Reyes, Ana Teresa Mantilla Suárez, Juan Carlos Uribe Caputi, Juan Carlos
dc.contributor.author.none.fl_str_mv	Rey Ayala, Milena
dc.contributor.cvlac.spa.fl_str_mv	Araújo Reyes, Ana Teresa [0000117925] Mantilla Suárez, Juan Carlos [0001482827] Uribe Caputi, Juan Carlos [0001435212]
dc.contributor.googlescholar.spa.fl_str_mv	Uribe Caputi, Juan Carlos Alberto [z6reFf8ZcCwC]
dc.contributor.orcid.spa.fl_str_mv	Uribe Caputi, Juan Carlos Alberto [0000-0002-4971-339X]
dc.contributor.researchgate.spa.fl_str_mv	Uribe Caputi, Juan Carlos Alberto [Juan_Uribe-Caputi]
dc.contributor.apolounab.spa.fl_str_mv	Uribe Caputi, Juan Carlos [juan-carlos-alberto-uribe-caputi]
dc.subject.keywords.spa.fl_str_mv	Medical sciences Health sciences Radiology Diagnostic imaging White matter hyperintensities Migraine Patient Magnetic resonance imaging Cephalalgia Demographic characteristics Imaging systems in medicine
topic	Medical sciences Health sciences Radiology Diagnostic imaging White matter hyperintensities Migraine Patient Magnetic resonance imaging Cephalalgia Demographic characteristics Imaging systems in medicine Ciencias médicas Radiología Diagnóstico para imágenes Resonancia magnética Cefalalgia Características demográficas Sistemas de imágenes en medicina Ciencias de la salud Hiperintensidades de sustancia blanca Migraña Paciente
dc.subject.lemb.spa.fl_str_mv	Ciencias médicas Radiología Diagnóstico para imágenes Resonancia magnética Cefalalgia Características demográficas Sistemas de imágenes en medicina
dc.subject.proposal.spa.fl_str_mv	Ciencias de la salud Hiperintensidades de sustancia blanca Migraña Paciente
description	Introducción: Las hiperintensidades de sustancia blanca son cada vez un hallazgo más frecuente en las resonancias magnéticas cerebrales y han sido descritas en numerosas patologías. Su diagnóstico diferencial dependerá de la localización, morfología y comportamiento en el tiempo y en las diferentes secuencias obtenidas. Algunos autores han encontrado asociación entre este hallazgo en resonancia magnética y la migraña, pudiendo ser explicado por los cambios de la microvasculatura cerebral. Sin embargo, no todos los textos concuerdan en esto, muchos autores no han encontrado asociación estadísticamente significativa entre estas dos patologías. Por tanto el objetivo del presente estudio es establecer la asociación entre el diagnóstico de migraña y las hiperintensidades de sustancia blanca en la resonancia magnética de pacientes menores de 50 años con impresión diagnóstica de cefalea en un centro radiológico de referencia en Bucaramanga. Metodología: Se realizó un estudio analítico transversal en pacientes con cefalea que asistían a la toma de resonancia magnética cerebral de nuestra institución entre enero del 2022 y junio del 2022. Se incluyeron todos los pacientes menores de 50 años que aceptaron la participación en el estudio y se excluyeron aquellos pacientes con factores de riesgo cardiovascular como diabetes mellitus o hipertensión arterial y aquellos con enfermedad de sustancia blanca ya establecida. Resultados: Durante el periodo establecido se incluyeron 70 pacientes con migraña y 39 pacientes con otras cefaleas primarias, con edades comprendidas entre los 19 años y 49 años. La incidencia de las hiperintensidades de sustancia blanca fue de 42%. Los pacientes con hiperintensidades de sustancia blanca tenían mayor edad que aquellos que no las presentaban (35.2 años vs 31.5 años p 0.02). En el presente estudio no encontró asociación estadísticamente significativas entre la presencia de migraña e hiperintensidades de la sustancia blanca en resonancia magnética, así como tampoco con el resto de variables estudiadas incluyendo la presencia o no de aura, edad, localización, grado de severidad clínica ni radiológica. Conclusión: No se logró encontrar asociación entre las hiperintensidades de sustancia blanca y la migraña ni con las otras variables clínicas ni radiológicas a diferencia de otros estudios publicados en la literatura, por tanto, es necesario realizar estudios con mayor tamaño de muestral en nuestra población para aclarar la asociación entre estas dos entidades.
publishDate	2022
dc.date.issued.none.fl_str_mv	2022
dc.date.accessioned.none.fl_str_mv	2023-03-01T16:37:40Z
dc.date.available.none.fl_str_mv	2023-03-01T16:37:40Z
dc.type.driver.none.fl_str_mv	info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv	Tesis
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dc.type.redcol.none.fl_str_mv	http://purl.org/redcol/resource_type/TM
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dc.identifier.instname.spa.fl_str_mv	instname:Universidad Autónoma de Bucaramanga - UNAB
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dc.language.iso.spa.fl_str_mv	spa
language	spa
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Guideline for primary care management of headache in adults. Canadian Family Physician. 2015;61. Frishberg B, Rosenberg J, Matchar D, Mccoroy D. Evidence-Based Guidelines in the Primary Care Setting: Neuroimaging in Patients with Nonacute Headache. American Academy of Neurology. 2000. 28. Katz M. The cost-effective evaluation of uncomplicated headache. Med Clin North Am 2016;100:1009-17. 29. Bashir A, Lipton RB, Ashina S, Ashina M. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology. 2013;81(14):1260-8 30. Porter A, Gladstone JP, Dodick DW. Migraine and white matter hyperintensities. Curr Pain Headache Rep. 2005;9(4):289-93 31. Hamedani A, Rose K, Peterlin B, Mosley T, Coker L, Jack C, Knopman D, Alonso A, Gottesman R. Migraine and white matter hyperintensities: the ARIC MRI study. Neurology. 2013;81(15):1308–1313. 32. Kurth T, Mohamed S, Maillard P, Zhu Y, et al. Headache, migraine, and structural brain lesions and function: population based Epidemiology of Vascular Ageing-MRI study. BMJ 2011; 342: c7357 33. Wardlaw JM, Smith C, Dichgans M. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol. 2013;12(5):483-97. 34. Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, et al. STandards for ReportIng Vascular changes on nEuroimaging (STRIVE v1). Neuroimaging standards for research into small vessel disease and its contribution to aging and neurodegeneration. Lancet Neurol. 2013;12(8):822-38. 35. Fazekas F. Magnetic resonance signal abnormalities in asymptomatic individuals: their incidence and functional correlates. Eur Neurol. 1989;29(3):164-8 36. Oyama H, Kida Y, Tanaka T, Iwakoshi T, Niwa M, Kobayashi T. Incidental white matter lesions identified on magnetic resonance images of normal Japanese individuals--correlation with age and hypertension. Neurol Med Chir (Tokyo). 1994;34(5):286-90. 37. Longstreth W, Manolio T, Arnold A, Burke G, Bryan N, Jungreis C et al. Clinical Correlates of White Matter Findings on Cranial Magnetic Resonance Imaging of 3301 Elderly People. Stroke. 1996;27(8):1274-1282.. Neurol Med Chir (Tokyo). 1994;34(5):286-90. 38. Goadsby PJ. Migraine pathophysiology. Headache. 2005;45 Suppl 1:S14-24. 39. Bednarczyk EM, Remler B, Weikart C, Nelson AD, Reed RC. Global cerebral blood flow, blood volume, and oxygen metabolism in patients with migraine headache. Neurology. 1998;50(6):1736-40 40. Gozke E, Ore O, Dortcan N, Unal Z, Cetinkaya M. Cranial magnetic resonance imaging findings in patients with migraine. Headache. 2004;44(2):166-9. 41. Zimmerman RD, Fleming CA, Lee BC, Saint-Louis LA, Deck MD. Periventricular hyperintensity as seen by magnetic resonance: prevalence and significance. AJR Am J Roentgenol. 1986;146(3):443-50. 42. Rossato G, Adami A, Thijs VN, Cerini R, Pozzi-Mucelli R, Mazzucco S, Anzola GP, Del Sette M, Dinia L, Meneghetti G, Zanferrari C; SAM study group. Cerebral distribution of white matter lesions in migraine with aura patients. Cephalalgia. 2010;30(7):855-9. 43. Kanekar S, Devgun P. A pattern approach to focal white matter hyperintensities on magnetic resonance imaging. Radiol Clin North Am. 2014;52(2):241-61. 44. Gaillard, F. (s. f.). Fazekas scale for white matter lesions \| Radiology Reference Article \| Radiopaedia.org. Radiopaedia. Recuperado 13 de julio de 2021, de https://radiopaedia.org/articles/fazekas-scale-for-white-matter-lesions 45. El Hasnaoui A, Vray M, Blin P, Nachit-Ouinekh F, Boureau F; HEMISHERE study group. Assessment of migraine severity using the MIGSEV scale: relationship to migraine features and quality of life. Cephalalgia. 2004;24(4):262-70 46. El Hasnaoui A, Vray M, Richard A, Nachit-Ouinekh F, Boureau F; MIGSEV Group. Assessing the severity of migraine: development of the MIGSEV scale. Headache. 2003;43(6):628-35. 47. Negm M, Housseini AM, Abdelfatah M, Asran A. Relation between migraine pattern and white matter hyperintensities in brain magnetic resonance imaging. Egypt J Neurol Psychiatr Neurosurg. 2018;54(1):24. 48. Palm-Meinders IH, Koppen H, Terwindt GM, Launer LJ, Konishi J, Moonen JM, Bakkers JT, Hofman PA, van Lew B, Middelkoop HA, van Buchem MA, Ferrari MD, Kruit MC. Structural brain changes in migraine. JAMA. 2012;308(18):1889-97. 48. Palm-Meinders IH, Koppen H, Terwindt GM, Launer LJ, Konishi J, Moonen JM, Bakkers JT, Hofman PA, van Lew B, Middelkoop HA, van Buchem MA, Ferrari MD, Kruit MC. Structural brain changes in migraine. JAMA. 2012;308(18):1889-97. 50. Monteith T, Gardener H, Rundek T, Dong C, Yoshita M, Elkind MS, DeCarli C, Sacco RL, Wright CB. Migraine, white matter hyperintensities, and subclinical brain infarction in a diverse community: the northern Manhattan study. Stroke. 2014;45(6):1830-2. 51. Igarashi, H., Sakai, F., Kan, S., Okada, J., & Tazaki, Y. Magnetic Resonance Imaging of The Brain in Patients With Migraine. Cephalalgia. 1991;11(2), 69–74. 52. Pavese, N., Canapicchi, R., Nuti, A., Bibbiani, F., Lucetti, C., Collavoli, P., & Bonuccelli, U. White Matter MRI Hyperintensities in a Hundred and Twenty-Nine Consecutive Migraine Patients. Cephalalgia. 1994; 14(5), 342–345.Brain in Patients With Migraine. Cephalalgia. 1991;11(2), 69–74. 54. Meilán, A., Larrosa, D., Ramón, C., Cernuda‐Morollón, E., Martínez‐Camblor, P., Saiz, A., … Pascual, J. No association between migraine frequency and white matter lesions and silent brain infarctions: a study in a series of chronic migraine women. European Journal of Neurology. 2020, 0: 1–8 53. Swartz RH, Kern RZ. Migraine Is Associated With Magnetic Resonance Imaging White Matter Abnormalities: A Meta-analysis. Arch Neurol. 2004;61(9):1366–1368. 55. Le Pira F, Reggio E, Quattrocchi G, Sanfilippo C, Maci T, Cavallaro T, Zappia M. Executive dysfunctions in migraine with and without aura: what is the role of white matter lesions? Headache. 2013;54(1):125–130. 56. Seneviratne U, Chong W, Billimoria P. Brain white matter hyperintensities in migraine: clinical and radiological correlates. Clin Neurol Neurosurg. 2013;115(7):1040–1043. 57. Ahmed SR, Mohamed AAM, Salem HH, Helmy S, Moustafa RR, Borham SMF. Association of white matter hyperintensities with migraine phenotypes and response to treatment. Acta Neurol Belg. 2022 Jul 19. 58. Onay M, Yıldoğan AT, Eren F. Relationship between headache, corpus callosum, and deep white matter lesions in patients with migraine. Cukurova Med J. 2022;47(1):436-445 59. Toghae M, Rahimian E, Abdollahi M, Shoar S, Naderan M. The prevalence of magnetic resonance imaging Hyperintensity in migraine patients and its association with migraine headache characteristics and cardiovascular risk factors. Oman Med J. 2015;30(3):203–207. 60. Zhang Q, Datta R, Detre J, Cucchiara B. White matter lesion burden in migraine with aura may be associated with reduced cerebral blood flow. Cephalalgia. 2016;37(6):517–524. 61. Trauninger A, Leél-Őssy E, Kamson D, Pótó L, Aradi M, Kövér F, Imre M, Komáromy H, Erdélyi-Botor S, Patzkó Á, Pfund Z. Risk factors of migraine-related brain white matter hyperintensities: an investigation of 186 patients. J Headache Pain. 2011;12(1):97–103. 62. Kruit M, van Buchem M, Launer L, Terwindt G, Ferrari M. Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study. Cephalalgia. 2010;30(2):129–136. 63. Rothwell P. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet. 2010;375(9718):938–948. 64. Cooney, B. S., Grossman, R. I., Farber, R. E., Goin, J. E., & Galetta, S. L. (1996). Frequency of magnetic resonance imaging abnormalities in patients with migraine. Headache: The Journal of Head and Face Pain, 36(10), 616–621. 65. Gomez-Beldarrain M, Oroz I, Zapirain B, Ruanova B, Fernandez Y, Cabrera A, Anton-Ladislao A, Aguirre-Larracoechea U, Garcıa-Monco J. Right fronto-insular white matter tracts link cognitive reserve and pain in migraine patients. J Headache Pain. 2016;17(1):4. 66. Chong C, Schwedt T. Migraine affects white-matter tract integrity: a diffusion-tensor imaging study. Cephalalgia. 2015;35(13):1162–1171.
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dc.publisher.faculty.spa.fl_str_mv	Facultad Ciencias de la Salud
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spelling	Araújo Reyes, Ana Teresaa260e912-ee80-486a-9445-f3c56b9562c8Mantilla Suárez, Juan Carlos8f451e23-7cb0-4c4f-82bb-82b1f4145c5bUribe Caputi, Juan Carlosaca03b19-80cb-4db8-9658-5f4dccbcc34eRey Ayala, Milena56063d62-2723-4f3a-b637-641ba9d8cd54Araújo Reyes, Ana Teresa [0000117925]Mantilla Suárez, Juan Carlos [0001482827]Uribe Caputi, Juan Carlos [0001435212]Uribe Caputi, Juan Carlos Alberto [z6reFf8ZcCwC]Uribe Caputi, Juan Carlos Alberto [0000-0002-4971-339X]Uribe Caputi, Juan Carlos Alberto [Juan_Uribe-Caputi]Uribe Caputi, Juan Carlos [juan-carlos-alberto-uribe-caputi]Bucaramanga (Santander, Colombia)20222023-03-01T16:37:40Z2023-03-01T16:37:40Z2022http://hdl.handle.net/20.500.12749/19154instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.coIntroducción: Las hiperintensidades de sustancia blanca son cada vez un hallazgo más frecuente en las resonancias magnéticas cerebrales y han sido descritas en numerosas patologías. Su diagnóstico diferencial dependerá de la localización, morfología y comportamiento en el tiempo y en las diferentes secuencias obtenidas. Algunos autores han encontrado asociación entre este hallazgo en resonancia magnética y la migraña, pudiendo ser explicado por los cambios de la microvasculatura cerebral. Sin embargo, no todos los textos concuerdan en esto, muchos autores no han encontrado asociación estadísticamente significativa entre estas dos patologías. Por tanto el objetivo del presente estudio es establecer la asociación entre el diagnóstico de migraña y las hiperintensidades de sustancia blanca en la resonancia magnética de pacientes menores de 50 años con impresión diagnóstica de cefalea en un centro radiológico de referencia en Bucaramanga. Metodología: Se realizó un estudio analítico transversal en pacientes con cefalea que asistían a la toma de resonancia magnética cerebral de nuestra institución entre enero del 2022 y junio del 2022. Se incluyeron todos los pacientes menores de 50 años que aceptaron la participación en el estudio y se excluyeron aquellos pacientes con factores de riesgo cardiovascular como diabetes mellitus o hipertensión arterial y aquellos con enfermedad de sustancia blanca ya establecida. Resultados: Durante el periodo establecido se incluyeron 70 pacientes con migraña y 39 pacientes con otras cefaleas primarias, con edades comprendidas entre los 19 años y 49 años. La incidencia de las hiperintensidades de sustancia blanca fue de 42%. Los pacientes con hiperintensidades de sustancia blanca tenían mayor edad que aquellos que no las presentaban (35.2 años vs 31.5 años p 0.02). En el presente estudio no encontró asociación estadísticamente significativas entre la presencia de migraña e hiperintensidades de la sustancia blanca en resonancia magnética, así como tampoco con el resto de variables estudiadas incluyendo la presencia o no de aura, edad, localización, grado de severidad clínica ni radiológica. Conclusión: No se logró encontrar asociación entre las hiperintensidades de sustancia blanca y la migraña ni con las otras variables clínicas ni radiológicas a diferencia de otros estudios publicados en la literatura, por tanto, es necesario realizar estudios con mayor tamaño de muestral en nuestra población para aclarar la asociación entre estas dos entidades.1. RESUMEN 2. PLANTEAMIENTO DEL PROBLEMA Y JUSTIFICACIÓN 3. MARCO TEÓRICO 4. ESTADO DEL ARTE 5. OBJETIVOS 5.1 Objetivo General 5.2 Objetivos Específicos 6 METODOLOGÍA 6.1 Tipo de estudio 6.2 Población y muestra 6.3 Criterios de inclusión y exclusión 6.4 Variables del estudio 7 PROCEDIMIENTO 8 DEPURACIÓN DE DATOS Y PLAN DE ANÁLISIS 9 CONSIDERACIONES ÉTICAS 10 CRONOGRAMA DE ACTIVIDADES 11 RESULTADOS 12 DISCUSIÓN 13 CONCLUSIÓN 14 REFERENCIAS BIBLIOGRÁFICAS 15 ANEXOSEspecializaciónIntroduction: White matter hyperintensities are an increasingly frequent finding in brain magnetic resonance imaging and have been described in numerous pathologies. Its differential diagnosis will depend on the location, morphology and behavior over time and on the different sequences obtained. Some authors have found an association between this finding in magnetic resonance imaging and migraine, which can be explained by changes in the cerebral microvasculature. However, not all texts agree on this, many authors have not found a statistically significant association between these two pathologies. Therefore, the objective of this study is to establish the association between the diagnosis of migraine and white matter hyperintensities in magnetic resonance imaging of patients under 50 years of age with a diagnostic impression of headache at a reference radiological center in Bucaramanga. Methodology: A cross-sectional analytical study was carried out in patients with headache who attended the brain magnetic resonance at our institution between January 2022 and June 2022. All patients under 50 years of age who agreed to participate in the study was included and patients with cardiovascular risk factors such as diabetes mellitus or arterial hypertension and those with already established white matter disease were excluded. Results: During the established period, 70 patients with migraine and 39 patients with other primary headaches, aged between 19 and 49 years, were included. The incidence of white matter hyperintensities was 42%. Patients with white matter hyperintensities were older than those who did not present them (35.2 years vs 31.5 years p 0.02). In the present study, no statistically significant association was found between the presence of migraine and white matter hyperintensities in magnetic resonance, neither with the rest of the variables studied, including the presence or absence of aura, age, location, degree of clinical severity or radiological. Conclusion: It was not possible to find an association between white matter hyperintensities and migraine or with other clinical or radiological variables, unlike other studies published in the literature, therefore, it is necessary to carry out studies with a larger sample in our population to clarify the association between these two entities.application/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)Atribución-NoComercial-SinDerivadas 2.5 Colombiahttp://purl.org/coar/access_right/c_abf2Hiperintensidades de sustancia blanca en pacientes con migrañaWhite matter hyperintensities in patients with migraineEspecialistas en Radiología e Imágenes DiagnósticasUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Radiología e Imágenes Diagnósticasinfo:eu-repo/semantics/masterThesisTesisinfo:eu-repo/semantics/acceptedVersionhttp://purl.org/redcol/resource_type/TMMedical sciencesHealth sciencesRadiologyDiagnostic imagingWhite matter hyperintensitiesMigrainePatientMagnetic resonance imagingCephalalgiaDemographic characteristicsImaging systems in medicineCiencias médicasRadiologíaDiagnóstico para imágenesResonancia magnéticaCefalalgiaCaracterísticas demográficasSistemas de imágenes en medicinaCiencias de la saludHiperintensidades de sustancia blancaMigrañaPaciente1. 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Cephalalgia. 2015;35(13):1162–1171.https://apolo.unab.edu.co/en/persons/juan-carlos-alberto-uribe-caputiORIGINAL2022_Tesis_Rey_Ayala_Milena.pdf2022_Tesis_Rey_Ayala_Milena.pdfTesisapplication/pdf591626https://repository.unab.edu.co/bitstream/20.500.12749/19154/1/2022_Tesis_Rey_Ayala_Milena.pdfc02f7da5598bea674efd7a4ff230b429MD51open access2022_Licencia_Rey_Ayala_Milena.pdf2022_Licencia_Rey_Ayala_Milena.pdfLicenciaapplication/pdf768992https://repository.unab.edu.co/bitstream/20.500.12749/19154/2/2022_Licencia_Rey_Ayala_Milena.pdffe51785d30b1ac3bbd90d5e1d7f59780MD52open accessLICENSElicense.txtlicense.txttext/plain; charset=utf-8829https://repository.unab.edu.co/bitstream/20.500.12749/19154/3/license.txt3755c0cfdb77e29f2b9125d7a45dd316MD53open accessTHUMBNAIL2022_Tesis_Rey_Ayala_Milena.pdf.jpg2022_Tesis_Rey_Ayala_Milena.pdf.jpgIM Thumbnailimage/jpeg4411https://repository.unab.edu.co/bitstream/20.500.12749/19154/4/2022_Tesis_Rey_Ayala_Milena.pdf.jpg4a1ae1d9ab849143532aadd794d86532MD54open access2022_Licencia_Rey_Ayala_Milena.pdf.jpg2022_Licencia_Rey_Ayala_Milena.pdf.jpgIM Thumbnailimage/jpeg9567https://repository.unab.edu.co/bitstream/20.500.12749/19154/5/2022_Licencia_Rey_Ayala_Milena.pdf.jpg7c54e438be4d1d77f090b3bc915f1051MD55open access20.500.12749/19154oai:repository.unab.edu.co:20.500.12749/191542023-03-01 22:01:21.184open accessRepositorio Institucional \| Universidad Autónoma de Bucaramanga - UNABrepositorio@unab.edu.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

Hiperintensidades de sustancia blanca en pacientes con migraña

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