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if they developed suddenly, subdural hematoma is not likely to be the explanation A brain tumor, especially a rapidly growing glioblastoma multiforme or lymphoma, may produce a severe hemiplegia within a week or two Also, the neurologic de cit due to carcinoma metastatic to the cerebrum may evolve rapidly, almost at a stroke-like pace Moreover, in rare cases, the hemiplegia may be preceded by transitory episodes of neurologic de cit, indistinguishable from TIAs However, in both conditions, a detailed history will indicate that the evolution of symptoms was gradual; if it was saltatory, seizures will usually have occurred The chest lm frequently discloses a primary or secondary tumor, and an increased blood sedimentation rate suggests that a concealed systemic disease process is at hand A lack of detailed history may also be responsible for the opposite diagnostic error, ie, mistaking a relatively slowly evolving stroke (usually due to internal carotid artery or basilar occlusion) for a tumor Again, CT scanning and MRI will usually settle the problem A brain abscess or in ammatory necrotic lesion eg, herpes encephalitis or toxoplasmosis may also develop rapidly Dementia of the Alzheimer type is often ascribed, on insuf cient and conceptually incorrect grounds, to the occurrence of multiple small strokes If vascular lesions are responsible, evidence of an apoplectic episode or episodes and of focal neurologic de cit to account for at least part of the syndrome will almost invariably be disclosed by history and examination In the absence of a history of episodic development or of focal neurologic signs, it is unwarranted to attribute senile dementia to cerebrovascular disease in particular to small strokes in silent areas Cerebral arteriosclerosis is another term that has often been used carelessly to explain such mental changes, the implication (incorrect) being that arteriosclerosis itself causes ischemic damage to the nervous system, producing loss of intellectual function but no other neurologic de cit If cerebral arteriosclerosis (atherosclerosis) is actually responsible, there should be evidence of it in the form of strokes at some time in the course of the illness and often in the heart (myocardial infarction, angina pectoris) or legs (intermittent claudication, loss of pulses) Frequently the lesions of both vascular and Alzheimer disease are present, in which case there may be dif culty in determining to what extent each of them is responsible for the neurologic de cit Several studies have shown an increased incidence or an acceleration of Alzheimer dementia if there are concurrent vascular lesions, but further studies are needed to con rm this notion Recurrent seizures as the result of a previous stroke occur in up to 10 percent of cases ( postinfarction epilepsy, page 740) When evidence, by history or examination, of the original stroke is lacking, as it often is, or if the seizures are not observed or leave behind a temporary increase in the neurologic de cit (Todd s paralysis), the diagnosis of another stroke or a tumor may be made in error Miscellaneous conditions occasionally taken to be a stroke are Bell s palsy; Stokes-Adams attacks; a severe attack of labyrinthine vertigo; diabetic ophthalmoplegia; acute ulnar, radial, or peroneal palsy; embolism to a limb; and temporal arteritis associated with blindness Contrariwise, certain manifestations of stroke may be incorrectly interpreted as evidence of some other neurologic disorder In lateral medullary infarction, dysphagia may be the outstanding feature; if the syndrome is not kept in mind, a fruitless radiologic search for a local esophageal or pharyngeal cause may be undertaken Similarly, facial pain or a burning sensation due to involvement of the trigeminal spinal nucleus in lateral medullary stroke may be misattributed to sinus disease Headache, at times severe,.

often occurs as a prodrome of a thrombotic stroke or subarachnoid hemorrhage; unless this is appreciated, a diagnosis of migraine may be made Dizzy spells, vertigo, vomiting, or brief intermittent lapses of equilibrium due to vascular disease of the brainstem may be ascribed to vestibular neuronitis, Meniere disease, Stokes-Adams ` syncope, or gastroenteritis A detailed account of the attack will usually avert this error A strikingly focal monoplegia of cerebral origin, causing only weakness of the hand or arm or foot drop, is not infrequently misdiagnosed as a peripheral neuropathy In the presence of coma, the differentiation of vascular from other neurologic diseases offers special problems If the patient is comatose when rst seen and an adequate history is not available, cerebrovascular lesions must be differentiated from all the other causes of coma described in Chap 17 and commented on below

Moving on to Step 3 in this process, shown next, you begin to get into the details of setting up the initial frontend for the business users In this case, we are assigning characteristics to be available as filter characteristics in report execution Any characteristics that are identified here will show up under the Filter setting in your Web report Again, just remember not to allow the filler NULL to appear in any fields

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