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The weakness of the concept is that it may lead to premature acceptance of anatomic and physiologic mechanisms that are overly simplistic The locale of the lesion that causes loss of a language function does not localize the language function itself, a warning enunciated long ago by Hughlings Jackson Nevertheless, the language disorders described below occur with suf cient regularity and clinical uniformity to be as useful as the more classic and common types of aphasia in revealing the complexity of language functions Conduction Aphasia As indicated earlier, Wernicke theorized that certain clinical symptoms would follow a lesion that effectively separated the auditory and motor language areas without directly damaging either of them Since then, a number of wellstudied cases have been described that conform to his proposed model of Leitungsaphasie (conduction aphasia), which is the name he gave it.

The characteristic feature is one of severely impaired repetition; the defect applies to both single words and nonwords The second essential feature is an affected but relatively preserved comprehension in comparison to Wernicke s aphasia In other respects, the features of conduction aphasia resemble those of a mild Wernicke s aphasia There is a similar uency and paraphasia in self-initiated speech, in repeating what is heard, and in reading aloud; writing is invariably impaired Dysarthria and dysprosody are usually lacking Speech output is normal or somewhat reduced As mentioned, comprehension is by no means perfect, but compared with one who has Wernicke s aphasia, the patient with conduction aphasia has relatively little dif culty in understanding words that are heard or seen and is aware of his de cit.

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The lesion in the few autopsied cases has been located in the cortex and subcortical white matter in the upper bank of the left sylvian ssure, usually involving the supramarginal gyrus and occasionally the most posterior part of the superior temporal region The reason for classifying this aphasia as a disconnection syndrome.

Type Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic Ceramic

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We said that the information store on an Exchange server can contain up to 15 storage groups and that each storage group can contain up to six data stores. Actually that s not quite true: Exchange supports up to 16 storage groups, but you are only allowed to create 15. The 16th storage group is reserved for use during database-recovery operations. Similarly, Exchange actually supports up to 16 6 96 data stores, but in practice you can only create 15 6 90. The six possible data stores of the 16th storage group are reserved for recovery operations.

Fig. 16-12

(See also Chap 34) This particular type of in ammatory disease of cranial arteries is an important cause of headache in elderly persons All of our patients have been more than 55 years of age, most of them above age 65 From a state of normal health, the patient develops an increasingly intense throbbing or nonthrobbing headache, often with superimposed sharp, stabbing pains In a few patients the headache has had an almost explosive onset The pain is usually unilateral, sometimes bilateral, and often localized to the site of the affected arteries in the scalp The pain persists to some degree throughout the day and is particularly severe at night It lasts for many months if untreated (average duration, 1 year) The super cial temporal and other scalp arteries are frequently thickened and tender and without pulsation.

Jaw claudication and ischemic nodules on the scalp, with ulceration of the overlying skin, have been described in severe cases Many of the patients feel generally unwell and have lost weight; some have a low-grade fever and anemia Usually the sedimentation rate is greatly elevated ( 50 mm/h and usually over 75 mm/h), and a few patients have a neutrophilic leukocytosis As many as 50 percent of patients have generalized aching of proximal limb muscles, re ecting the presence of polymyalgia rheumatica (see page 189) The importance of early diagnosis relates to the threat of blindness from thrombosis of the ophthalmic or posterior ciliary arteries This may be preceded by several episodes of amaurosis fugax (transient monocular blindness, page 692) Ophthalmoplegia may also occur but is less frequent, and its cause, whether neural or muscular, is not settled The large intracranial vessels are occasionally affected.

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