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tensive encephalopathy, amyotrophic lateral sclerosis, and multiple sclerosis, as already indicated; but in a number of less common processes, such as progressive supranuclear palsy and Wilson disease, it may be quite a prominent feature Abrupt onset, of course, points to vascular disease Placidity and Apathy These may be the earliest and most important signs of cerebral disease Clinically, placidity and apathy must be distinguished from the akinesia or bradykinesia of Parkinson disease and the reduced mental activity of depressive illness Here, Alzheimer disease, normal-pressure hydrocephalus, and frontal corpus callosum tumors are the most common pathologic states underlying apathy and placidity, but these disturbances may complicate a variety of other frontal and temporal lesions, such as those occurring with demyelinative disease or as an aftermath of ruptured anterior communicating aneurysm Outbursts of Rage and Violence Most often such an outburst is but another episode in a lifelong sequence of sociopathic behaviors (see Chap 56) More signi cance attaches to its abrupt appearance as a sudden departure from an individual s normal personality If an outburst of rage accompanies a seizure, the rage should be viewed as the consequence of the disruptive effect of seizure activity on temporal lobe function; however, as indicated earlier, an outburst of uncontrolled rage and violence is only rarely a manifestation of psychomotor epilepsy Lesser degrees of poorly directed combative behavior, as part of ictal or postictal automatism, are more common Rarely, rage and aggressivity are expressive of an acute neurologic disease that involves the mediotemporal and orbitofrontal regions, such as a glioma We have several times observed such states in the course of a dementing disease and in a stable individual as a transient expression of an obscure encephalopathy Rage reactions with continuous violent activity must be distinguished from mania, in which there is ight of ideation to the point of incoherence, euphoric or irritable mood, and incessant psychomotor activity; from organic drivenness, in which continuous motor activity, accompanied by no clear ideation occurs, usually in a child, as an aftermath of encephalitis; and from extreme instances of akathisia, where incessant restless movements and pacing may occur in conjunction with extrapyramidal symptoms Extreme Fright and Agitation Here the central problem must be clari ed by determining whether the patient is delirious (clouding of consciousness, psychomotor overactivity, and hallucinations), deluded (schizophrenia), manic (overactive, ight of ideas), or experiencing an isolated panic attack (palpitation, trembling, feeling of suffocation, etc) Rarely does panic prove to be an expression of temporal lobe epilepsy In an adult without a characterologic trait of anxiety, an acute panic attack may signify the onset of a depressive illness or schizophrenia Bizarre Ideation Developing over Weeks or Months While these symptoms are usually due to a psychosis (schizophrenia or manic-depressive disease), one should consider a tumor or other lesion of the temporal lobe, particularly when accompanied by psychomotor seizures, aphasic symptoms, rotatory vertigo (rare), and quadrantic visual eld defects Such states have also been described in hypothalamic disease, suggested by somnolence, diabetes insipidus, visual eld defects, and hydrocephalus (see Chap 27). java upc-a Generate UPC-A barcode in Java class using Java UPC-A ...
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c# qr code reader webcam Integrate UPC-A barcode generation function to Java applications for drawing UPC-A in Java . eclipse birt qr code Aside from clinical observation, there are no reliable means of evaluating or quantifying the emotional disorders described above While neurologic medicine has done little more than describe and classify some of the clinical states dominated by emotional derangements, knowledge of this type is nonetheless of both theoretical and practical importance In theory, it prepares one for the next step, of passing from a super cial to a deeper order of inquiry, where questions of pathogenesis and etiology can be broached Practically, it provides certain clues that are useful in differential diagnosis A number of particular neurologic possibilities must always be considered when one is confronted with one of the following clinical states Uninhibited Laughter and Crying and Emotional Lability As indicated earlier, one may con dently assume that the syndrome of forced or spasmodic laughing and crying signi es cerebral disease and more speci cally bilateral disease of the corticobulbar tracts (see Table 25-2) Usually the motor and re ex changes of spastic bulbar (pseudobulbar) palsy described on page 426 are associated, especially heightened facial and mandibular re exes ( jaw jerk ) and often corticospinal tract signs in the limbs as well Extreme emotional lability also indicates bilateral cerebral disease, although only the signs of unilateral disease may be apparent clinically The most common pathologic bases for these clinical states are lacunar infarction or other cerebrovascular lesions, diffuse hypoxic-hypo- java upc-a racca3141/UPC: Build a UPC-A label. - GitHub
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