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The Wernicke s area was spared, refuting the prediction at the time of Marie Inexplicably, Broca attributed the aphasic disorder to the lesion of the frontal operculum alone Broca ignored the rest of the lesion, which he considered to be a later spreading effect of the stroke Perhaps he was in uenced by the prevailing opinion of the time (1861) that articulation was a function of the inferior parts of the frontal lobes The fact that Broca s name later became attached to a discrete part of the inferior frontal cortex helped to entrench the idea that Broca s aphasia equated with a lesion in the Broca s area However, as pointed out above, a lesion con ned only to this area gives rise to a relatively modest and transient motor speech disorder (Mohr et al) or to no disorder of speech at all (Goldstein).

As indicated earlier, opiates also act pre- and postsynaptically on the neurons of laminae I and V of the dorsal horn, suppressing afferent pain impulses from both the A- and C bers Furthermore, these effects can be reversed by the narcotic antagonist naloxone Interestingly, naloxone can reduce some forms of stimulationproduced analgesia Levine and colleagues have demonstrated that not only does naloxone enhance clinical pain but it also interferes with the pain relief produced by placebos These observations suggest that the heretofore mysterious bene cial effects of placebos (and perhaps of acupuncture) may be due to activation of an endogenous system that shuts off pain through the release of painrelieving endogenous opioids, or endorphins (see below) Prolonged pain and fear are the most powerful activators of this endogenous opioid-mediated modulating system.

Health education for students, families, and staff Health counseling, including referrals and follow-up Age-appropriate health screenings, referrals, and follow-up

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Motor speech disorders, both severe Broca s aphasia and the more restricted and transient types, are most often due to a vascular lesion Embolic infarction in the territory of the upper (rolandic, superior) division of the middle cerebral artery is the most frequent type of stroke and results in the most abrupt onset and sometimes the most rapid regression of aphasia (hours or days), depending on whether the ischemia proceeds to tissue necrosis Even with the latter, however, ischemia around the zone of infarction causes a more extensive syndrome than one might expect from the infarct itself, ie, the physiologic impairment initially exceeds the pathologic.

The same system is probably operative under a variety of other stressful conditions; for example, some soldiers, wounded in battle, require little or no analgesic medication ( stress-induced analgesia ) The opiates also act at several loci in the brainstem, at sites corresponding with those producing analgesia when stimulated electrically and generally conforming to areas in which neurons with endorphin receptors are localized..

Because of the distribution of the superior branch of the middle cerebral artery, there are a frequently associated right-sided faciobrachial paresis and a left-sided manual-brachial apraxia (socalled sympathetic apraxia), due probably to interruption of the bers that connect the left and right motor cortices Atherosclerotic thrombosis, primary or metastatic tumor, subcortical hypertensive, traumatic or anticoagulant-induced hemorrhage, and seizure, should they involve the appropriate parts of the motor cortex, may also declare themselves by a Broca s aphasia A closely related syndrome, pure word mutism (aphemia), causes the patient to be wordless (mute) but leaves inner speech intact and writing undisturbed Anatomically, this is believed to be in the nature of a disconnection of the motor cortex for speech from lower centers and is described with the dissociative speech syndromes discussed further on in this chapter.

drive cleaning processes, documented procedures for system reconstruction (especially AD reconstruction), and so on. This review should be based on a checklist that you use to validate each of the elements that support system recovery. Document any changes you bring to this strategy after you complete the review. You should also run an automated system recovery (ASR) backup job on each of your servers. The ASR backup is run manually because it creates a recovery diskette. It should be run once a month to make sure the ASR diskette is up-to-date. It should also be run whenever you make significant changes to any server. ASR captures system state, installed services, all information about the disks installed in the system, and how to restore the server. To run an ASR backup: 1. Use the Global MMC Console to open a Remote Desktop Connection to the server you want to verify. Launch NTBackup (Quick Launch Area | Backup). Make sure it launches in Advanced mode. 2. In the Backup Welcome screen, click Automated System Recovery. This launches the ASR Wizard. Click Next. 3. Select the type and the name of the backup, then click Next. 4. Click Finish to begin the ASR backup. Make sure you have a diskette on hand to create the ASR boot disk. Store your ASR disks in a safe place.

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