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clusions of the larger vessels as well as aneurysms, vascular malformations, and other blood vessel diseases such as arteritis To a large degree, conventional dye-injection angiography has been supplanted by magnetic resonance angiography (MRA; Fig 34-1) and venography (MRV) for the visualization of large intracranial arteries and veins; these have the advantage of safety but do not yet give re ned images of the smaller vessels and are not as accurate as angiography in measuring the severity of stenosis of a vessel New CT techniques called spiral CT angiography now offer images of better resolution, comparable to conventional arteriograms They have the additional advantage of demonstrating soft tissues and bone adjacent to these vessels, thus providing the surgeon with important anatomic information (see Chap 2) Lumbar puncture indicates whether blood has entered the subarachnoid space (from aneurysm, vascular malformation, hypertensive hemorrhage, and some instances of hemorrhagic infarction) The cerebrospinal uid (CSF) is clear in cases of pale infarction from thrombosis and embolism In most stroke cases, the CT scan or MRI, neither of which entails any risk to the patient, precludes the need for lumbar puncture and conventional angiography The electroencephalogram (EEG) has lost favor in stroke diagnosis but is probably underutilized as a readily available means of detecting cortical infarction in the wake of ischemia of a region of one hemisphere It allows a distinction to be made between occlusion of a small and a large vessel, because focal EEG abnormalities are sparse or absent with a deep lacunar stroke The EEG is most useful soon after the stroke, when the only available alternative is the CT scan, which often does not visualize the infarct until several days have passed

The example illustrates a table for a Gantt chart; it contains three categories and no data for some start and end times The substeps are the Project Steps: Chart, Object Services, and Web Runtime The categories are the Work Packages: Concept Creation, Specification, and Solution Validation Once this information is applied to the Gantt chart type, the final result would be something similar to the display in the following illustration

Several factors are known to increase the liability to stroke, and it has been here that large-scale public health measures have had a

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substantial in uence The most important of these are hypertension, heart disease, atrial brillation, diabetes mellitus, cigarette smoking, and hyperlipidemia Others, such as systemic diseases associated with a hypercoagulable state and the use of birth control pills, also contribute, but only in special circumstances Hypertension is the most readily recognized factor in the genesis of primary intracerebral hemorrhage It appears that the stroke-producing potential of hypertension is as much the product of heightened systolic pressure as of diastolic pressure (Fisher; Rabkin et al) The cooperative studies of the Veterans Administration (see Freis et al) and the report by Collins and associates (collating 14 randomized trials of antihypertensive drugs) have convincingly demonstrated that the long-term control of hypertension decreases the incidence of both atherothrombotic infarction and intracerebral hemorrhage And simple measures such as the use of hydrochlorthiazide for blood pressure control may be overall the most effective The presence of congestive heart failure and coronary atherosclerosis also greatly increases the probability of stroke As for embolic strokes, the most important risk factors are structural cardiac disease and arrhythmias, particularly atrial brillation, which increases the incidence of stroke about six-fold, and by eighteen-fold if there is also rheumatic valvular disease Bacterial and nonbacterial (marantic) endocarditis and right-to-left shunts between the cardiac chambers or in the lung also predispose to embolic stroke Diabetes hastens the atherosclerotic process in both large and small arteries; Weinberger and colleagues and Roehmholdt and coworkers have found diabetic patients to be twice as liable to stroke as agematched nondiabetic groups Also, Homer and Ingall and their colleagues have documented the importance of long-duration cigarette smoking in the development of carotid atherosclerosis The interactions between diabetes and hypertension on the one hand and intracerebral hemorrhage and atherothrombotic infarction on the other as well as the association of cardiac disease and cerebral embolism are considered further on in this chapter, in relation to.

each of these categories of cerebrovascular disease Subsidiary factors, such as low potassium intake and reduced serum levels of potassium, have been associated with an increased stroke rate in several studies, including one that we conducted, but the mechanism of this effect is obscure (Green et al); a detrimental effect on blood pressure is possible Numerous clinical trials have also shown a marked reduction in stroke incidence with the use of cholesterol-lowering drugs Public health measures designed to detect and reduce the aforementioned risk factors offer the most intelligent long-range approach to the prevention of cerebrovascular disease

July 1800 call at 194 if the market was still around 18 If the underlying was at 2000, we could look at the 1600 call option and guess at theoretical price of around 295 Option models are more accurate, and you can specify dates, prices, volatility, and so on, but this is a simple on-the- y method to use to calculate your option value

30 31 1 2 3 4 5 6 7 8 9

are frequently bilateral and occur in conjunction with cranial nerve palsies and other segmental brainstem and cerebellar signs; quadriparesis, hemiparesis, and/or unilateral or bilateral sensory impairment are typical, coupled with diplopia, dysarthria, and vertigo in various combinations

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