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tracts, medial longitudinal fasciculi, pontine nuclei, vestibular and cochlear nuclei, descending hypothalamospinal sympathetic bers, and the third through eighth cranial nerves (the nuclei and their segments within the brainstem) The complete basilar syndrome comprises bilateral long tract signs (sensory and motor) with variable cerebellar, cranial nerve, and other segmental abnormalities of the brainstem Often the patient is comatose because of ischemia of the high midbrain reticular activating system Others are mute and quadriplegic but conscious, re ecting interruption of descending motor pathways in the base of the pons but sparing of the reticular activating system ( lockedin syndrome; see page 305) Midbasilar disease may also cause coma if the posterior communicating arteries are inadequate to perfuse the distal basilar artery territory In the presence of the full syndrome, it is usually not dif cult to make the correct diagnosis The aim should be, however, to recognize basilar insuf ciency long before the stage of total de cit has been reached The early manifestations (in the form of TIAs) occur in many combinations, described in detail further on (page 692) Basilar Branch Occlusion Occlusion of branches at the bifurcation (top) of the basilar artery results in a remarkable number of complex syndromes that include, in various combinations, somnolence or coma, memory defects, akinetic mutism, visual hallucinations, ptosis, disorders of ocular movement (convergence spasm, paralysis of vertical gaze, retraction nystagmus, pseudoabducens palsy, retraction of upper eyelids, skew deviation of the eyes), an agitated confusional state, and visual defects These have been reviewed by Petit and coworkers and Castaigne and associates as paramedian thalamic, subthalamic, and midbrain infarction syndromes and by Caplan as the top of the basilar syndrome The main signs of occlusion of the superior cerebellar artery are ipsilateral cerebellar ataxia of the limbs (middle and/or superior cerebellar peduncles); nausea and vomiting; slurred speech; and loss of pain and thermal sensation over the opposite side of the body (spinothalamic tract) Partial deafness, static tremor of the ipsilateral upper extremity, an ipsilateral Horner syndrome, and palatal myoclonus have also been reported, but we have not seen these With occlusion of the anteroinferior cerebellar artery (AICA), the extent of the infarct is extremely variable, since the size of this artery and the territory it supplies vary inversely with the size and territory of supply of the posteroinferior cerebellar artery (PICA) The principal ndings are vertigo, vomiting, nystagmus, tinnitus and sometimes unilateral deafness; facial weakness; ipsilateral cerebellar ataxia (inferior or middle cerebellar peduncle); an ipsilateral Horner syndrome and paresis of conjugate lateral gaze; and contralateral loss of pain and temperature sense of the arm, trunk, and leg (lateral spinothalamic tract) The tinnitus may be overwhelming, called screaming by some of our patients If the occlusion is close to the origin of the artery, the corticospinal bers may also be involved, producing a hemiplegia; if distal, there may be cochlear and labyrinthine infarction Cerebellar swelling has not occurred in our cases or in the 20 collected by Amarenco and Hauw The most characteristic manifestation of all these branch or division brainstem infarcts is the crossed cranial nerve and long tract sensory or motor de cit These crossed syndromes, which may involve cranial nerves III through XII, are listed in Table 34-3 Although the nding of bilateral neurologic signs strongly suggests brainstem involvement, it must be emphasized that in many instances of infarction within the basilar territory, the signs are lim-.

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Weber syndrome III III Red nucleus and brachium conjunctivum Red nucleus, corticospinal tract, and brachium conjunctivum Superior cerebellar peduncles Corticospinal tract

Vascular occlusion, tumor, aneurysm Vascular occlusion, tumor, aneurysm Infarct, hemorrhage, tuberculoma, tumor

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process should put you in pretty good shape immediately upon starting the process As with any new system, you will need some time to bone up on some of the features and also how to navigate within the Crystal components rather than having to search and experiment with the parameters while trying to make your deadline for report requirements So, let s take a look at some results of using Crystal Reports and compare some of the features with, say, Report Designer I ve found that working with Crystal Reports is much easier than working with the Report Designer Again, I m a firm believer in the SAP BI toolsets, but as soon as you start to work with each of the reporting components, you will immediately see the differences In the following illustration, you can see that even Crystal Reports can get into the dashboard mania

Oculomotor palsy with crossed hemiplegia Oculomotor palsy with contralateral cerebellar ataxia and tremor Oculomotor palsy with contralateral cerebellar ataxia, tremor, and corticospinal signs Ocular palsies, paralysis of gaze, and cerebellar ataxia Paralysis of upward gaze and accommodation; xed pupils

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Parinaud syndrome Supranuclear mechanism for upward gaze and other structures in periaqueductal gray matter VII and often VI Corticospinal tract

681 X X, XII Spinal V, IX, X, XI Lateral spinothalamic tract Descending pupillodilator bers Spinocerebellar and olivocerebellar tracts

In Figure 22 you can see a sample of a stock option ticker symbol In the tables shown in Figure 23 and Figure 24 you can see the month and strike price codes The root symbol is the symbol for options on the underlying stock or instrument The root symbol is not necessarily the same as the underlying stock ticker symbol, so make sure that you look up the option symbol for the stock in question In Figure 23 we show the expiration month codes for stock options Call options are from A L, and put options are M X In Figure 24 you can see the strike price codes for equity options You will be looking for the strike prices nearest to the current price

This example shows the use of indicators, line chart types, pie chart types, and parameters that are changeable on the fly (click the name and the data changes to that specific person) This is a very nice dashboard, with well-positioned information and a focus on specific information Dashboarding is not something that everyone using Crystal Reports is looking to do, but it is possible and very straightforward to complete The hierarchy to the left of the chart also enables you to switch the information to a specific country Executing this process changes the look of this report but it will still have the look and feel of a dashboard rather than a formatted report You would be correct in saying that this is not the best business

Facial and abducens palsy and contralateral hemiplegia; sometimes gaze palsy to side of lesion Paralysis of soft palate and vocal cord and contralateral hemianesthesia Spinothalamic tract; sometimes descending pupillary bers, with Bernard-Horner syndrome Corticospinal tract

Avellis syndrome plus ipsilateral tongue paralysis Ipsilateral V, IX, X, XI palsy, Horner syndrome and cerebellar ataxia; contralateral loss of pain and temperature sense

See Wolf JK, The Classical Brainstem Syndromes Spring eld, Charles C Thomas, 1971 for translations of orginal reports

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