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regular, or intermittent respiration; dilated, xed pupils, rst on the side of the clot; and occasionally by decerebrate rigidity. The widespread use of CT scanning has disclosed the frequent occurrence of smaller putaminal hemorrhages, which in former times would have been misdiagnosed as embolic or thrombotic ischemic strokes (especially if the CSF was clear). With hemorrhages con ned to the anterior segment of the putamen, the hemiplegia and hyperre exia tend to be less severe and to clear more rapidly (Caplan). There is also prominent abulia, motor impersistence, temporary unilateral neglect, and with left-sided lesions non uent aphasia and dysgraphia. With posterior lesions, weakness is also less and is attended by sensory loss, hemianopia, impaired visual pursuit to the opposite side, Wernicke-type aphasia (leftsided lesions), and anosognosia (right-sided). Caplan has also analyzed the effects of relatively pure caudate hematoma. Those extending laterally and posteriorly into the internal capsule behave much like large putaminal hemorrhages. Those extending medially into the lateral ventricle give rise to drowsiness, stupor, and either confusion and underactivity or restlessness and agitation. Thalamic Hemorrhage The central feature here is severe sensory loss on the entire contralateral body. If large or moderate in size, thalamic hemorrhage also produces a hemiplegia or hemiparesis by compression or destruction of the adjacent internal capsule (Fig. 34-21). The sensory de cit is usually severe and involves all of the opposite side, including the trunk, and may exceed the motor weakness. A uent aphasia may be present with lesions of the dominant side, and amorphosynthesis and contralateral neglect with lesions of the nondominant side. A homonymous eld defect, if present, usually clears in a few days. Thalamic hemorrhage, by virtue of its extension into the sub-
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THE PERIODIC PARALYSES AND HEREDITARY, NONDYSTROPHIC MYOTONIAS
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follows the If clause, and each succeeding block of code coupled with a condition is an ElseIf clause. You can have as many ElseIf clauses as you want. Finally, you may optionally have an Else clause, which, as with an If...Then...Else statement, acts as none of the above. After the If...ElseIf statement finishes executing, execution continues with any code following the statement. The syntax of an If...ElseIf statement is shown here:
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<script language = "javascript"> function getDocumentElement() { var XMLHttpRequestObject = false; if (window.XMLHttpRequest) { XMLHttpRequestObject = new XMLHttpRequest(); } else if (window.ActiveXObject) { XMLHttpRequestObject = new ActiveXObject("Microsoft.XMLHTTP"); } if(XMLHttpRequestObject) { XMLHttpRequestObject.open("GET", "party.xml", true); XMLHttpRequestObject.onreadystatechange = function() { if (XMLHttpRequestObject.readyState == 4 && XMLHttpRequestObject.status == 200) { var xmlDocument = XMLHttpRequestObject.responseXML; var documentElement = xmlDocument.documentElement; . . . } } } } } </script>
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You should also regularly verify the status of your web servers and the web sites they host. This task is set to a weekly frequency, but depending on the criticality of your
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N OTE You may not have these bitmap files installed, or they may be installed at a different location, depending on the particular edition you purchased or your installation options. Choose the Cut bitmap file for the Cut toolbar button and then click the Open button. As shown here, the Select Resource dialog box now contains the image for Cut.
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Vascular occlusion, tumor, aneurysm Vascular occlusion, tumor, aneurysm Infarct, hemorrhage, tuberculoma, tumor
45: Adjusting 3D Models
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If one adheres faithfully to the clinical method outlined here, neurologic diagnosis is greatly simpli ed. In most cases one can reach an anatomic diagnosis. The cause of the disease may prove more elusive and usually entails the intelligent and selective employment of a number of the laboratory procedures described in the next chapter. However, even after the most assiduous application of the clinical method and laboratory procedures, there are numerous patients whose diseases elude diagnosis. In such circumstances we have often been aided by the following rules of thumb: 1. Focus the clinical analysis on the principal symptom and signs and avoid being distracted by minor signs and uncertain clinical data. As mentioned earlier, when the main sign has been misinterpreted say a tremor has been taken for ataxia or fatigue for weakness the clinical method is derailed from the start. Avoid early closure of diagnosis. Often this is the result of premature xation on some item in the history or examination, closing the mind to alternative diagnostic considerations. The rst diagnostic formulation should be regarded as only a testable hypothesis, subject to modi cation when new items of information are secured. Should the disease be in a stage of transition, time will allow the full picture to emerge and the diagnosis to be clari ed. When several of the main features of a disease in its classic form are lacking, an alternative diagnosis should always be entertained. In general, however, one is more likely to encounter rare manifestations of common diseases than the typical manifestations of rare diseases (a paraphrasing of Bayes theorem). It is preferable to base diagnosis on one s experience with the dominant symptoms and signs and not on statistical analyses of the frequency of clinical phenomena. For the most part the methods of probability-based decision analysis have proved to be disappointing in relation to neurologic disease because of the impossibility of weighing the importance of each clinical datum. Whenever reasonable and safe, obtain tissue for examination, for this adds the certainty of histopathology to the clinical study.
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INCOORDINATION AND OTHER DISORDERS OF CEREBELLAR FUNCTION
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