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supranuclear palsy and central pontine myelinolysis, of which pseudobulbar palsy is a frequent manifestation, forced laughing and crying are less dramatic or, in many cases, absent Therefore the pathologic emotional state cannot be equated with pseudobulbar palsy even though the two usually occur together Is this pathologic state, whether one of involuntary laughing or of crying, activated by an appropriate stimulus In other words, does the emotional response accurately re ect the patient s affect or feeling There are no simple answers to these questions One problem, of course, is to determine what constitutes an appropriate stimulus for the patient in question Virtually always, the emotional response is set off by some stimulus or thought; but usually it is tri ing, or at least it appears so to the physician Merely addressing the patient or making some casual remark in his presence may suf ce Certainly the emotional response is out of all proportion to the stimulus Oppenheim and others stated that these patients need not feel sad when crying or mirthful when laughing, and at least in some cases this is in agreement with our experience Other patients, however, do report a congruence of affect and emotional experience Noteworthy also are the stereotyped nature of the initial motor facial response and the relatively undifferentiated nature of the emotional reaction Laughter or crying, as each proceeds, may merge, one with the other Poeck puts great emphasis on the latter point, but it does not seem surprising when one considers the closeness of these two forms of emotional expression a feature that is particularly evident in young children Normal persons may cry when overjoyed and smile when sad More impressive to us is the fact that in some patients with pseudobulbar palsy, laughing and crying, or caricatures thereof, are the only available forms of emotional expression; intermediate phenomena, such as smiling and frowning, are lost In other patients with pseudobulbar palsy, it seems to us, there are lesser degrees of forced laughing and crying, perhaps bridging the gap between this phenomenon and the type of emotional lability discussed earlier Wilson, in his discussion of the anatomic basis and mechanism of forced laughing and crying, pointed out that both involve the same facial, vocal, and respiratory musculature and have similar visceral accompaniments (dilatation of facial vessels, secretion of tears, etc) Two major supranuclear pathways control the pontomedullary mechanisms of facial and other movements required in laughing and crying One is the familiar corticobulbar pathway that runs from the motor cortex through the posterior limb of the internal capsule and controls volitional movements; the other is a more anterior pathway which descends just rostral to the knee of the internal capsule and contains facilitatory and inhibitory bers Unilateral involvement of the anterior pathway leaves the opposite side of the face under volitional control but paretic during laughing, smiling, and crying (emotional facial paralysis); the opposite is observed with a unilateral lesion of the posterior pathway Wilson s argument, based to some extent on clinicopathologic evidence, was that in pseudobulbar palsy it was the descending motor pathways, which naturally inhibit the expression of the emotions, that were interrupted, although he was uncertain of the exact level Almost 40 years later, Poeck, after reviewing all the published pathologic anatomy in 30 veri ed cases, was able to do no more than conclude that supranuclear motor pathways are always involved, with loss of a control mechanism somewhere in the brainstem between thalamus and medulla However, this clinical state is observed in amyotrophic lateral sclerosis, where the corticobulbar tracts may be involved at a cortical and subcortical level As mentioned earlier, the lesions are bilateral in practically all instances (see Poeck in. generate pdf417 barcode c# C# PDF-417 Generator generate, create 2D barcode PDF-417 ...
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qr code generator in vb.net ... java-based barcode reader and generator library zxing - micjahn/ZXing. ... Patches · add patch file for a k-d-tree implementation in the PDF417 decoder (j… barcode generator project source code in java the References) There are, however, reports of spasmodic laughter lasting a month or two, following unilateral striatocapsular infarction (Ceccaldi et al), and occasional cases after unilateral pontine infarction or arteriovenous malformation, but these cases have not been veri ed pathologically Of interest is the bene cial effect on distressing pseudobulbar displays of drugs such as imipramine and uoxetine (Schiffer et al) A study has also shown bene t from dextromethorphan combined with quinidine in the pseudobulbar state of ALS (Brooks et al) In a number of personally observed cases, both the emotional lability and pathologic laughter and crying were partially suppressed by these drugs; in others there was no effect Several small series have demonstrated a reduction in the intensity of both forced crying and laughter with the use of antidepression drugs in the majority of patients A rare but probably related syndrome is le fou rire prodromique (prodromal laughing madness) of Fere, in which uncontrol lable laughter begins abruptly and is followed after several hours by hemiplegia We have seen two such cases in which basilar artery occlusion evolved after a brief bout of such forced laughter Martin cites examples where patients laughed themselves to death Again, the pathologic anatomy is unsettled Protracted laughing and (less often) crying may occur also as a manifestation of epileptic seizures, usually of psychomotor type Ictal laughter is usually without affect Daly and Mulder referred to these as gelastic seizures The concurrence of gelastic seizures and precocious puberty is highly characteristic of an underlying hamartoma (or other lesion) of the hypothalamus (see Chaps 16 and 27) c# pdf417 barcode generator C#.NET PDF-417 Generator Control - Generate PDF417 Barcode in ...
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qr code reader java download Find out most popular NuGet pdf417 Packages. ... generation and recognition component, written in managed C# , it allows developers to quickly and easily add ... how to make qr code generator in vb.net . Aggressiveness is an integral part of social behavior The emergence of this trait early in life enables the individual to secure a position in the family and later in an ever-widening social circle Individual differences, probably inherited, are noteworthy Timidity, for example, is a persistent trait, recognized in infancy (Kagan) Males tend to be more aggressive than females The degree to which excessively aggressive behavior is tolerated varies in different cultures In most civilized societies, tantrums, rage reactions, and outbursts of violence and destructiveness are not condoned, and one of the principal objectives of training and education is the suppression and sublimation of such behavior The rate at which this developmental process proceeds varies from one individual to another In some, especially males and the mentally backward, it is not complete until 25 to 30 years of age; until that time, the deviant behavior is called sociopathy (see Chap 28) Undoubtedly, from our own casual and others more systematic observations, this is in part an inherited tendency That seemingly groundless outbreaks of unbridled but disorganized rage may rarely represent the initial or main manifestation of disease is not fully appreciated A patient with these symptoms may, with little provocation, change from a reasonable state to one of the wildest rage, with a blindly furious impulse to violence and destruction In such states the patient appears out of contact with reality and is impervious to all argument or pleading As far as one can tell, this pattern of behavior is associated with a feeling of anger What is so obviously abnormal is the provocation of the attack by some tri ing event and a degree of violence that is out of all proportion to the stimulus There are examples also of a dissociation of affect and behavior in which the patient may spit, cry out, attack, or bite without seeming to be angry This is especially true of the mentally retarded. The following illustration is an example of a very good dashboard that follows most of the rules in terms of color, emphasis of the primary KPIs with additional colors and some dimensionality, and much better titles to identify exactly what we are looking at . free pdf417 barcode generator c# Which free C# library can generate PDF-417 barcodes? - Stack Overflow
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