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From eqn. (4.133), the radius such that P (RCEP ) = 0.5 is computed as 0.5 = 1 exp 2 ln(2) RCEP = 1.1774.

Hydrocephalus (continued ) neuropathologic effects of, 535 occult, 534f, 534 535 overt, 534 pathogenesis of, 533 534 otitic, 538 posttraumatic, 764 saccular aneurysms and, 718 tension, in meningitis, bacterial, 595t Hydrochlorothiazide, for hyperkalemia periodic paralysis, 1269 Hydrogen peroxide poisoning, 1039 Hydromorphone, for pain, 124t Hydromyelia, 1086 Hydroxyacyl-CoA dehydrogenase de ciency, 1235 Hymenoptera stings, 1034 Hypalgesia, de nition of, 118, 118t, 135 Hyperalgesia, de nition of, 118, 118t Hyperammonemias, inherited, 802 803 Hyperbilirubinemia, hereditary, 878 Hypercalcemia encephalopathy associated with, 973 muscle and, 1096 in neonates, 804 Hypercapnic pulmonary disease, 964 965 Hyperekplexia, 90 Hypereosinophilic syndrome, 1138 Hyperesthesia, de nition of, 118, 118t, 135 Hyperexplexia, 90 Hyperextension injuries, spinal, 1050 Hyperglycemia, 966 967 syncope versus, 328 329 Hyperglycinemia, nonketotic form of, in neonates, 802 Hyperhidrosis, 466 Hyperkalemia, 972 Hyperkalemic periodic paralysis, 1266t, 1268 1270 Hyperkinetic dysarthria, 427 Hypermetria, 76, 225 Hypernatremia, 972 Hyperosmia, 198 Hyperosmolar nonketotic hyperglycemia, 966 967 Hyperpathia de nition of, 118, 118t, 135 in peripheral nerve disease, 1115 Hyperperfusion syndrome, after carotid endarterectomy, 698 699 Hyperre exia, 46 47, 48t Hypersensitivity meningitis associated with, 635 vasculitis associated with, 733 Hypersexuality, 449

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when the mechanism and causation of the disease can be determined, the etiologic diagnosis This may include the rapidly increasing number of molecular and genetic etiologies if they have been worked out for a particular process 5 Finally, the physician should assess the degree of disability and determine whether it is temporary or permanent ( functional diagnosis); this is important in managing the patient s illness and judging the potential for restoration of function It goes without saying that all of these steps are undertaken in the service of effective treatment, an ever-increasing prospect in neurology As will be emphasized repeatedly in later sections, there is therefore always a premium in the diagnostic process on the discovery of treatable diseases The foregoing approach to the diagnosis of neurologic disease is summarized in Fig.

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When you re talking about romantic love, it s probably fair enough to expect love to just happen. But compassion doesn t just happen: Like the other leadership qualities discussed in this chapter, compassion must be nurtured and developed. Heart power is the strength of this world, my father used to tell his audiences, and hate power is the weakness of the world. In order to create an organization of character and integrity, you have to lead with compassion with heart power and you have to create an environment in which the people you are leading can show compassion for each other.

bacterial meningitis is not speci c but a re ection of hypochloremia and, to a slight degree, of a greatly elevated CSF protein Acid-base balance in the CSF is of considerable interest in relation to metabolic acidosis and alkalosis Normally the pH of the CSF is about 731 ie, somewhat lower than that of arterial blood, which is 741 The PCO2 in the CSF is in the range of 45 to 49 mmHg ie, higher than in arterial blood (about 40 mmHg) The bicarbonate levels of the two uids are about the same, 23 meq/L The pH of the CSF is precisely regulated, and it tends to remain relatively unchanged even in the face of severe systemic acidosis and alkalosis Measurements of acid-base balance in the CSF, while of interest, have only limited clinical value.

Acid-base changes in the lumbar CSF do not necessarily re ect the presence of similar changes in the brain, nor are the CSF data as accurate an index of the systemic changes as direct measurements of arterial blood gases The ammonia content of the CSF is one-third to one-half that of the arterial blood; it is increased in hepatic encephalopathy, the inherited hyperammonemias, and the Reye syndrome; the concentration corresponds roughly with the severity of the encephalopathy The uric acid content of CSF is about 5 percent of that in serum and varies with changes in the serum level (high in gout, uremia, and meningitis and low in Wilson disease) The urea concentration in the CSF is slightly lower than that in the serum; in uremia, it rises in parallel with that in the blood.

Mn/2

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