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CHAPTER 2 Patterns of Life
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That year was one of the most challenging and dif cult of my life. I taught a self-contained class of ninth-grade males with EBD and quickly realized that I was ill-prepared to perform many of the requisite tasks. I was responsible for teaching all the courses in the ninthgrade curriculum, and that in itself was daunting. I struggled with lesson planning, behavior management, special education paperwork, school committees, and a general lack of support from the administration, regular educators, and parents. There were enough inspiring moments and connections with students to see me through, but by the spring I knew that the only way I could continue in the eld was to go back to school full-time and learn how to do all the things that were expected in the job. The year as a master s degree student was incredibly valuable. I returned to public school with a renewed enthusiasm for working with youngsters with challenging behaviors and academic de cits.
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5. Press z-R or click the Run button on the toolbar to run the script. 6. Save the script under a name of your choice.
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4: Command Entry
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Part Two 325 Question 15-8
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An important segment of neurologic medicine and one that is seen with great frequency in general hospitals consists of disorders in which a global disturbance of cerebral function (encephalopathy) results from failure of some other organ system heart and circulation, lungs and respiration, kidneys, liver, pancreas, and the endocrine glands. Unlike the diseases considered in Chap. 37, in which a genetic abnormality affects the metabolic functions of many organs and tissues, including the brain, the cerebral disorders discussed in this chapter are strictly secondary to derangements of the visceral organs themselves. They stand at the interface of internal medicine and neurology. Relationships of this type, between an acquired disease of some thoracic, abdominal, or endocrine organ and the brain, have rather interesting implications. In the rst place, recognition of the neurologic syndrome may be a guide to the diagnosis of the systemic disease; indeed, the neurologic symptoms may be more informative and signi cant than the symptoms referable to the organ primarily involved. Moreover, these encephalopathies are often reversible if the systemic dysfunction is brought under control. Neurologists must therefore have an understanding of the underlying medical disorder, for this may provide the means of controlling the neurologic part of the disease. In other words, the therapy for what appears to be a neurologic disease lies squarely in the eld of internal medicine a clear reason why every neurologist should be well trained in internal medicine. Of more theoretical importance, the investigation of the acquired metabolic diseases may provide new insights into the chemistry and pathology of the brain. To select a single example, the discovery of an episodic encephalopathy that is associated with advanced liver disease and portocaval shunts opened a vast new area in brain chemistry, pertaining to the effect of ammonia on glutamine metabolism, and has brought to light an intriguing histopathologic change a relatively pure hyperplasia of protoplasmic astrocytes. Each visceral disease affects the brain in a somewhat different way, and since the pathogenic mechanism is not completely understood in any of them, the study of these metabolic diseases promises rich rewards to the scientist. In Table 40-1 the acquired metabolic diseases of the nervous system are classi ed according to their most common modes of clinical expression. Not included are the diseases due to nutritional de ciencies and those due to exogenous drugs and toxins, which can be considered metabolic in the broad sense; these are presented in the following chapters.
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