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velopment of spasticity in the arm or the early appearance of a grasp re ex may presage a favorable outcome In some patients with extensive temporoparietal lesions, the hemiplegia remains accid; the arm dangles and the slack leg must be braced to stand The physiologic explanation of this remains obscure If the internal capsule is not interrupted completely in a stroke that involves the lenticular nucleus or thalamus, the paralysis may give way to hemichoreoathetosis, hemitremor, or hemiataxia, depending upon the particular anatomy of the lesion Bowel and bladder control usually returns; sphincteric disorders persist in only a few cases Often the hemiplegic limbs are at rst tender and ache on manipulation Nevertheless, physiotherapy should be initiated early in order to prevent pseudocontracture of muscles and periarthritis at the shoulder, elbow, wrist, knuckles, knee, and ankle These are frequent complications and often the source of pain and added disability, particularly of the shoulder Occasionally, atrophy of bone and pain in the hand may accompany the shoulder pain (shoulderhand syndrome) An annoying feeling of dizziness and unsteadiness often persists after damage to the vestibular system in brainstem infarcts Convulsive (epileptic) seizures are relatively uncommon sequelae of thrombotic strokes in comparison to embolic cortical infarcts, which are followed by seizures in up to 10 percent of patients Most often in our experience, the EEG in these cases had never normalized and showed sharp activity over the region of the infarct even many months after the stroke (see further on for advice on the treatment of seizures after stroke) Many patients complain of fatigability and are depressed, possibly more so after strokes that involve the left frontal lobe (Starkstein et al) The explanation of these symptoms is uncertain; some are certainly expressions of a reactive depression Only a few patients develop serious behavior problems or are psychotic after a stroke, but paranoid trends, confusion, ill temper, stubbornness, and peevishness may appear, or an apathetic state ensues Large lesions affect concentration as well as synthetic and executive mental functions in general proportion to their size; these mental changes are independent of any disturbances in language function Finally, in regard to prognosis, it must be mentioned that having had one thrombotic stroke, the patient is at increased risk in the ensuing months and years of having a stroke at the same or another site, especially if there is hypertension or diabetes mellitus When multiple infarcts occur over a period of months or years, special types of dementia may develop, in addition to focal cerebral de cits In some of these cases, the major lesions involve the white matter, with relative sparing of the cortex and basal ganglia; the lesions may be lacunar or larger in size This disorder, often referred to as Binswanger subcortical leukoencephalopathy, probably represents the accumulation of multiple white matter infarcts and lacunes (pages 707 and 909) (see Mohr and Mast and Babikian and Ropper) The parts of the white matter that are destroyed tend to lie in the border zones between the penetrating cortical and basal ganglionic arteries The large patches of subcortical myelin loss and gliosis, in combination with small cortical and subcortical infarcts, produce a special radiologic image This still incompletely understood process and the histologically similar but biologically unique inherited condition of white matter termed CADASIL are discussed further on During the period 1970 1974 in Rochester, Minnesota, 94 percent of patients with ischemic strokes survived for 5 days and 84 percent for 1 month (Garraway et al) The survival rate was 54 percent at 3 years and 40 percent at 7 years In each of these groups,.

survival was signi cantly greater than it had been during the period 1965 1969 Among long-term survivors, heart disease is a more frequent cause of death than additional strokes These gures, which were gathered retrospectively, are comparable to more recent ones reported by Bamford and colleagues The mortality rate following cerebral infarcts in general (no separation being made between thrombotic and embolic types) at the end of 1 month was 19 percent and at the end of 1 year, 23 percent Of the survivors, 65 percent were capable of an independent existence Our colleague J Hinchey has repeatedly pointed out that pneumonia as a result of faulty swallowing is a major determinant of survival; further discussion regarding aspiration problems following stroke are to be found on pages 477 and 699

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Open Existing Web Template If you already have been working with some Web templates, then you can access them from this link In my case, if I see anything that is labeled as a wizard I m heading for that to see if I can work something out a bit easier than starting from scratch, so this is where we go to access the BI Consumer Patterns and other BI shortcut templates If you execute this option, a dialog box pops up that gives you access to these patterns The following illustration shows the results of this process The initial screen and tab List of Patterns and Web Templates to access all of the standard BI templates for use in developing a BI Pattern Template is shown This tab just shows you the default option that is chosen from the second tab, All Patterns and Web Templates So once you start to use each of the individual templates that we will look at shortly and you save and leave this dialog box, it stores the last template in this tab for easy access to what you were working on in the last session This reduces the amount of time and effort required to restart your work