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the distal internal carotid and proximal to its bifurcation An occlusion here blocks the ow in the small deep penetrating vessels as well as in super cial cortical branches; alternatively, an occlusion at the distal end of the stem blocks the ori ces of the divisions of the artery in the sylvian sulcus but leaves unaffected the more proximal deep penetrating vessels The picture of total occlusion of the stem is one of contralateral hemiplegia (face, arm, and leg), hemianesthesia, and homonymous hemianopia (due to infarction of the lateral geniculate body), with deviation of the head and eyes toward the side of the lesion; in addition, there is a variable but usually global aphasia with left hemispheric lesions and anosognosia and amorphosynthesis with a right-sided ones (see Chap 22) In the beginning, the patient may be dull or stuporous because of an ill-de ned effect of widespread paralysis of neurologic function Once fully established, the motor, sensory, and language deficits remain static or improve very little as months and years pass If the patient is globally aphasic for a prolonged period of time, he seldom ever again communicates effectively (see Chap 23 on the aphasic disorders) Occlusion of branches of the middle cerebral artery gives rise to only parts of the symptom complex If there are adequate collateral vessels over the surface of the hemisphere, only those component of the stroke referable to the deep structures are evident (mainly hemiplegia encompassing the contralateral limbs and face, as discussed below, under Deep MCA Territory Occlusion ), the cortical elements then being absent or mild (aphasia, agnosia, etc) Occlusion of the stem of the middle cerebral artery by a thrombus, contrary to conventional teaching, is relatively infrequent (less than 10 percent of middle cerebral artery occlusions in our experience); cerebral embolism is a more common cause Pathologic studies over the years have shown that most carotid occlusions are thrombotic, whereas most middle cerebral occlusions are embolic (Fisher, 1975; Caplan, 1989) The emboli tend to lodge in the stem or, more often, drift into super cial cortical branches; not more than 1 in 20 will enter deep penetrating branches that originate in the stem The middle cerebral artery may, however, become stenotic from atherosclerosis In several series of such cases, the permanent stroke was preceded by TIAs, producing a picture resembling that of carotid stenosis (see Day; Caplan) MCA Branch (Superior and Inferior Division) Occlusion Superior Division An embolus entering the middle cerebral artery most often lodges in one of its two main branches, the superior division (supplying the rolandic and prerolandic areas) or the inferior division (supplying the lateral temporal and inferior parietal lobes) Major infarction in the territory of the superior division causes a dense sensorimotor de cit in the contralateral face, arm, and, to a lesser extent, leg as well as ipsilateral deviation of the head and eyes; ie, it mimics the syndrome of stem occlusion except that the foot is spared and the leg is less involved than the arm and face ( brachiofacial paralysis ); there is no impairment of alertness If the occlusion is lasting (not merely transient ischemia with disintegration of the embolus), there will be slow improvement; after a few months, the patient will be able to walk with a spastic leg, while the motor de cits of the arm and face remain The sensory de cit may be profound, resembling that of a thalamic infarct (pseudothalamic syndrome of Foix), but more often it is less severe than the motor de cit, taking the form of stereoanesthesia, agraphesthesia, impaired position sense, tactile localization, and two-point discrimination as well as variable changes in touch, pain,.

Middle Cerebral Artery (MCA)

This artery has super cial and deep hemispheral branches Through its cortical branches, it supplies the lateral (convexity) part of the cerebral hemisphere (Fig 34-4) Its cortical territory encompasses (1) cortex and white matter of the lateral and inferior parts of the frontal lobe including motor areas 4 and 6, contraversive centers for lateral gaze and motor speech area of Broca (dominant hemisphere); (2) cortex and white matter of the parietal lobe, including the sensory cortex and the angular and supramarginal convolutions; and (3) superior parts of the temporal lobe and insula, including the sensory language areas of Wernicke The deep penetrating or lenticulostriate branches of the middle cerebral artery supply the putamen, part of the head and body of the caudate nucleus, the outer globus pallidus, the posterior limb of the internal capsule, and the corona radiata (Fig 34-5) The size of both the middle cerebral artery and the territory that it supplies is larger than those of the anterior and posterior cerebral arteries MCA Stem (M1) Occlusion The middle cerebral artery may be occluded in its stem (the term M1 is used by radiologists to denote this portion of the vessel), the portion that is distal to its origin at

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Where a live query is not feasible, LiveOffice is a good option However, the LiveOffice documents should also be optimized to ensure good dashboard performance Ensure that you are on the latest patch levels for Xcelsius, BusinessObjects Enterprise (BOE), and BW A number of product issues have been enhanced, so the latest Fix Packs provide all the resolutions for issues identified earlier The Fix Packs are synchronized and rely on each other, so it is not sufficient to only patch the BOE servers or the BW system alone So, let s look at some examples of the results of using Xcelsius This is where you really see the difference between the WAD and Xcelsius The following illustration shows a finished dashboard generated by Xcelsius functionality