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Arachnoid Cyst ( Localized Pseudotumor ) This lesion, which is probably congenital, presents clinically at all ages but may become evident only in adult life, when it gives rise to symptoms of increased intracranial pressure and sometimes to focal cerebral or cerebellar signs, simulating intracranial neoplasm. Seizures may occur but are not characteristic; we have seen only one instance. In infants and young children, macrocrania and extensive unilateral transillumination are characteristic features. Usually these cysts overlie the sylvian ssure; occasionally they are interhemispheric under the frontal lobes or lie in the pineal region or under the cerebellum. They may attain a large size, to the point of enlarging the middle fossa and elevating the lesser wing of the sphenoid, but they do not communicate with the ventricle. Rarely, one of these cysts may cover the entire surface of both cerebral hemispheres and create a so-called external hydrocephalus (page 533). The cysts are readily recognized (often accidentally) on the nonenhanced CT scan or MRI, showing a circumscribed tissue defect lled with uid that has the density of CSF (Gandy and Heier). If these cysts are completely asymptomatic, they should be left alone; if symptomatic, additional (MRI) studies are indicated, so as not to overlook a chronic subdural hematoma, which is often associated and may not be visualized on the unenhanced CT scan. Suprasellar arachnoid cysts are discussed further on (page 577). The treatment of enlarging and symptomatic cysts is marsupialization or, less preferably, by shunting from the cyst to the subarachnoid space.

It too is associated with malabsorption syndrome, ill-de ned weakness, ataxia, dysesthesia of the legs, and Babinski signs There is no sensory loss Tangier Disease This is a rare familial disorder of which we have seen four cases, inherited as an autosomal recessive trait It is named for the island off the Virginia coast where the rst-described patients resided The genetic abnormality eliminates the function of the so-called ATP-cassette transporter protein It results in a de ciency of high-density lipoprotein, low serum cholesterol, diminution of phospholipids, and high triglyceride concentrations in the serum Perhaps because of these abnormalities, the patients are disposed to early and severe atherosclerosis The presence of enlarged, yellow-orange (cholesterol-laden) tonsils is said to be a frequent manifestation (two of our patients had had previous tonsillectomies so that this sign was not evident).

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About half of the reported cases have had neuropathic symptoms, taking the form of an asymmetrical sensorimotor neuropathy that uctuates in severity The sensory loss is predominantly for pain and temperature and extends over the entire body; at times it is limited to the face and upper extremities simulating syringomyelia (pseudosyringomyelia) Tactile and proprioceptive sensory modalities tend to be preserved The polyneuropathy may come in attacks that is to say, it is recurrent In the two sisters reported by Engel and coworkers, the onset of symptoms was in childhood and in infancy, respectively Muscular weakness, if present, affects either the lower or upper extremities or both, particularly the hand muscles, which may undergo atrophy and show denervation by EMG In a small number of patients there has been facial diplegia out of proportion to weakness elsewhere In one of our patients, the pain and tem-.

Problem A Imagine a number. We add it to half of itself, and then add the result to 1/5 of itself. The final sum is equal to 51/10. What is the original number Solution A The first step in solving any word problem is to set up an equation representing that problem. Let s call our unknown number x. The statement of the problem tells us that if we take x, then add x /2 to that, and then add x /5 to that, we get 51/10. The equation is

Table 18-1

The Microsoft command-prompt interface is not case sensitive, by default. If you are using a different environment that is case sensitive, such as Linux/Unix, the screenshots in this chapter may not show the proper case for your environment.

According to the set-based definition of the natural numbers 0, 1, 2, 3, and so on, what number is represented by the entire set N

Radiography and CT may be normal or abnormal Vestibular paresis on caloric testing Directional preponderance CT and MRI abnormal Vestibular paresis on caloric testing BAEPs abnormal Increased CSF protein Hyperactive labyrinths or directional preponderance on caloric testing CT, MRI, and BAEPs abnormal in most cases No change in caloric responses CT and EEG may be abnormal

CREATE TABLE CustomerAddress ( CustomerNumber CHAR (3 NOT NULL, 0) CustomerStreet CHAR (30) , CustomerCity CHAR(30), Customerstate CHAR(2), , CustomerZip CHAR (10) CustomerCtry CHAR(5))

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