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and temperature sense With left-sided lesions there is initially a global aphasia, which changes gradually to a predominantly motor (Broca) aphasia, with improvement in comprehension of spoken and written words and the emergence of an effortful, hesitant, grammatically simpli ed, and dysmelodic speech (Chap 23); or there is a Broca aphasia from the outset Embolic occlusion limited to one of the branches of the superior division, perhaps the most common stroke seen in clinical practice, produces a more circumscribed infarct that further fractionates the above described syndrome With occlusion of the ascending frontal branch, the motor de cit is limited to the face and arm with little or no affection of the leg, and the latter, if weakened at all, soon improves; with left-sided lesions, there is dys uent and agrammatic speech, with normal comprehension (page 418).

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Plot the feasible region and identify the optimal solution 72 Duckwheat is produced in Kansas and Mexico and consumed in New York and California Kansas produces 15 shnupells of duckwheat and Mexico 8 Meanwhile, New York consumes 10 shnupells and California 13 The transportation costs per shnupell are $4 from Mexico to New York, $1 from Mexico to California, $2 from Kansas to New York, and $3 and from Kansas to California Write a linear program that decides the amounts of duckwheat (in shnupells and fractions of a shnupell) to be transported from each producer to each consumer, so as to minimize the overall transportation cost 73 A cargo plane can carry a maximum weight of 100 tons and a maximum volume of 60 cubic meters.

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Embolic occlusion of the rolandic branches results in sensorimotor paresis with severe dysarthria but little evidence of aphasia A cortical-subcortical branch occlusion may give rise to a brachial monoplegia Embolic occlusion of ascending parietal and other posterior branches of the superior division may cause no sensorimotor de cit but only a conduction aphasia (page 421) and bilateral ideomotor apraxia There are many other limited stroke syndromes or combinations of the aforementioned syndromes relating to small regions of damage in the frontal, parietal, or temporal lobes Most of these are discussed in Chap 22, on lesions in particular parts of the cerebrum Improvement can be expected within a few weeks to months but often some remnant of the original problem remains in place.

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As indicated earlier, the distal territory of the middle cerebral artery may also be rendered ischemic by failure of the systemic circulation, especially if the carotid artery is stenotic; this may simulate embolic branch occlusions Inferior Division Occlusion of the inferior division of the middle cerebral artery is slightly less frequent than occlusion of the superior one, but again is nearly always due to embolism The usual result in left-sided lesions is a Wernicke aphasia, which generally remains static for days or weeks, or a month or two, after which some improvement can be expected (page 419) In less extensive infarcts from branch occlusions (superior parietal, angular, or posterior temporal), the de cit in comprehension of spoken and written language may be especially severe.

Again, after a few months, the de cits usually improve, often to the point where they are evident only in self-generated efforts to read and copy visually presented words or phrases With either right- or left-hemispheric lesions, there is usually a superior quadrantanopia or homonymous hemianopia and, with right-sided ones, a left visual neglect and other signs of amorphosynthesis; rarely, an agitated confusional state, presumably from temporal lobe damage, may be a prominent feature of dominant hemispheral lesions and sometimes of nondominant ones Deep MCA ( MCA Stem, M1) Territory Occlusion (Striatocapsular Infarction) A number of interesting syndromes occur with deep lesions in the territory of the penetrating vessels of the middle cerebral artery (Figs 34-5 and 34-7) Most are attributable to emboli to the stem of the middle cerebral artery, although imaging studies show a patent vessel in half of the cases; a few are presumably atherothrombotic.

There have been few adequate pathologic studies Although centered in the deep white matter, most of these lesions are fragments of the cortical-subcortical stroke patterns described above The most common type in our experience has been a large striatocapsular infarction, similar to that described by Weller and colleagues All of their patients had some degree of hemiparesis and one- fth had aphasia or hemineglect..

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vb.net pdf 417 reader

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vb.net pdf 417 reader