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In 1950, Adams and Victor observed a rapidly evolving quadriplegia and pseudobulbar palsy in a young alcoholic man who had entered the hospital 10 days earlier with symptoms of alcohol withdrawal Postmortem examination several weeks later disclosed a large, symmetrical, essentially demyelinative lesion occupying the greater part of the base of the pons Over the next 5 years, three additional cases (two alcoholic patients and one with scleroderma) were studied clinically and pathologically, and in 1959 these four cases were reported by Adams et al under the heading of central pontine myelinolysis (CPM) This term was chosen because it denotes both the main anatomic localization of the disease and its essential pathologic attribute: the remarkably unsystematic dissolution of the sheaths of myelinated bers and the sparing of neurons Once attention was focused on this distinctive lesion, many other reports appeared.

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Part III:

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Figure 4.13 (A) Pre- and (B) immediately post two syringes (total 1.6 mL) of Juvederm Ultra into nasolabial folds. Topical anesthesia was used

The exact incidence of this disease is not known, but in a series of 3548 consecutive autopsies in adults, the typical lesion was found in 9 cases, or 025 percent (Victor and Laureno) Pathologic Features One is compelled to de ne this disease in terms of its pathologic anatomy, because this stands as its most certain feature Transverse sectioning of the xed brainstem discloses a grayish discoloration and ne granularity in the center of the basis pontis The lesion may be only a few millimeters in diameter, or it may occupy almost the entire basis pontis There is always a rim of intact myelin between the lesion and the surface of the pons Posteriorly it may reach and involve the medial lemnisci and, in the most advanced cases, other tegmental structures as well.

Figure 14-9

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Because this conversion is done by Visual Basic behind the scenes, it is referred to as an implicit conversion. By contrast, using the Parse method of the Integer class to explicitly (through your code) convert the string representation of an integer into an integer is referred to as an explicit conversion. The problem with implicit conversion is that Visual Basic does not always correctly guess your intentions. An example is the 2 + 2 = 22 result in the preceding section The Parse and ToString Methods. Accordingly, to be on the safe side, you can require conversions that have the potential for problems if done implicitly instead of explicitly. You set this requirement by setting Option Strict to On (as opposed to the default Off). There are two ways of setting Option Strict to On. One way is the statement Option Strict On at the top of your code:

Very rarely, the lesion encroaches on the midbrain, but inferiorly it does not extend as far as the medulla Exceptionally the extensive pontine lesions may be associated with identical myelinolytic foci symmetrically distributed in the thalamus, subthalamic nucleus, striatum, internal capsule, corpus callosum, amygdaloid nuclei, lateral geniculate body, white matter of the cerebellar folia, and deep layers of the cerebral cortex and subjacent white matter ( extrapontine myelinolysis ; Wright et al) Microscopically, the fundamental abnormality consists of destruction of the myelinated sheaths throughout the lesion, with relative sparing of the axons and intactness of the nerve cells of the pontine nuclei These changes always begin and are most severe in the geometric center of the pons, where they may proceed to frank necrosis of tissue Reactive phagocytes and glial cells are in evidence throughout the demyelinative focus, but oligodendrocytes are depleted Signs of in ammation are conspicuously absent.

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