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graphic tracing, motor-unit activity is more continuous in rigidity than in spasticity, persisting even after apparent relaxation A special feature that may accompany rigidity, rst noted by Negro in 1901, is the cogwheel phenomenon When the hypertonic muscle is passively stretched, eg, when the hand is dorsi exed, one encounters a rhythmically interrupted, ratchet-like resistance Most likely this phenomenon represents an associated tremor that, if not manifestly present, emerges faintly during manipulation It is therefore not a fundamental property of rigidity and is found in many tremulous states Rigidity is a prominent feature of many basal ganglionic diseases, such as Parkinson disease (late stages), Wilson disease, striatonigral degeneration (multiple system atrophy), progressive supranuclear palsy, dystonia musculorum deformans (all discussed in Chap 39), intoxication with neuroleptic drugs, and calcinosis of the basal ganglia The rigidity is characteristically variable in degree; in some patients with involuntary movements, particularly in those with chorea or dystonia, the limbs may actually be intermittently or persistently hypotonic Another distinctive type of variable resistance to passive movement is that in which the patient seems unable to relax a group of muscles on request When the limb muscles are passively stretched, the patient appears to actively resist the movement (gegenhalten, paratonia, or oppositional resistance) Natural relaxation normally requires concentration on the part of the patient If there is inattentiveness as happens with diseases of the frontal lobes, dementia, or other confusional states this type of oppositional resistance may raise a question of parkinsonian rigidity Actually this is not a manifestation of basal ganglia disorder per se but may indicate that the connections of the basal ganglia to the frontal lobes are impaired A similar dif culty in relaxation is observed normally in small children Not to be mistaken for rigidity or paratonia is the waxy exibility displayed by the psychotic patient when a limb placed in a suspended position is maintained for minutes in the identical posture As to pathophysiology, it is generally agreed that rigidity and bradykinesia result from lesions of the nigrostriatal system and that such lesions produce their effects through a series of sequential inhibitory and excitatory events involving the components and circuitry of the basal ganglia The normal activating effects of dopamine on both the direct and indirect striatopallidal systems and their effects on thalamocortical drive have been described earlier Degeneration of the pigmented cells of the substantia nigra deprives striatal neurons of their dopaminergic innervation, with the ultimate result that the normal thalamocortical drive is inhibited, culminating in rigidity, hypo- or akinesia, and bradykinesia.

Involuntary Movements (Chorea, Athetosis, Ballismus, Dystonia)

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In deference to usual practice, these symptoms are described separately, as though each represented a discrete clinical phenomenon readily distinguishable from the others In reality, they usually occur together or blend imperceptibly into each other and have many points of clinical similarity There are reasons to believe that they have a common anatomic and physiologic basis One must be mindful that chorea, athetosis, and dystonia are symptoms and are not to be equated with disease entities that happen to incorporate one of these terms in their names (eg, Huntington chorea, dystonia musculorum deformans) Here the discussion is limited to the

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Asymptomatic Neurosyphilis In this condition, there are no symptoms or physical signs except, in rare cases, abnormal pupils which are light-unreactive but accommodate Argyll-Robertson pupils (see page 242) The diagnosis is based entirely on the CSF ndings, which vary, as mentioned above Meningeal Syphilis Symptoms of meningeal involvement may occur at any time after inoculation but most often do so within the rst 2 years The most common symptoms are headache, stiff neck, cranial nerve palsies, convulsions, and mental confusion Occasionally headache, papilledema, nausea, and vomiting due to the presence of increased intracranial pressure are added to the clinical picture The patient is afebrile, unlike the case in tuberculous meningitis The CSF is always abnormal, more so than in asymptomatic syphilitic meningitis Obviously the meningitis is more intense in the symptomatic type and may be associated with hydrocephalus With adequate treatment, the prognosis is good The symptoms usually disappear within days to weeks, but if the CSF remains abnormal, it is likely that some other form of neurosyphilis will subsequently develop if treatment is not continued Meningovascular Syphilis This form of neurosyphilis should always be considered when a young person has one or several cerebrovascular accidents, ie, the sudden development of hemiplegia, aphasia, sensory loss, visual disturbance, or mental confusion As indicated earlier, this clinical syndrome is now probably the most common form of neurosyphilis Whereas in the past strokes accounted for only 10 percent of neurosyphilitic syndromes, their frequency is now estimated to be 35 percent The most common time of occurrence of meningovascular syphilis is 6 to 7 years after the original infection, but it may be as early as 9 months or as late as 10 to 12 years The CSF almost always shows some abnormality, usually an increase in cells, protein content, and gamma globulin as well as a positive serologic test However, most patients in middle or late life with stroke and only a positive serologic test will be found at autopsy to have nonsyphilitic atherothrombotic or embolic infarction rather than meningovascular syphilis The changes in the latter disorder consist not only of meningeal in ltrates but also of in ammation and brosis of small arteries (Heubner arteritis), which lead to narrowing and nally occlusion Most of the infarctions occur in the distal territories of medium- and small-caliber lenticulostriate branches that arise from the stems of the middle and anterior cerebral arteries Most characteristic perhaps is an internal capsular lesion, extending to the adjacent basal ganglia The presence of multiple small but not contiguous lesions adjacent to the lateral ventricles is another common pattern Small, asymptomatic lesions are often seen in the caudate and lenticular nuclei Several of our patients have had transient prodromal neurologic symptoms The neurologic signs that remain after 6 months will usually be permanent, but adequate treatment will prevent further vascular episodes If repeated cerebrovascular accidents occur despite adequate therapy, one must always consider the possibility of nonsyphilitic vascular disease of the brain Paretic Neurosyphilis (General Paresis, Dementia Paralytica, Syphilitic Meningoencephalitis) The general setting of this form of cerebral syphilis is a long-standing meningitis; as remarked.

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I have found that during the process of getting acquainted with the numerous components of BOBJ that I was having difficulty understanding where each one fits I m sure it was the same issues that I faced with BI before but I m guessing that the confusion was so long ago that I forget that there was any So I initially needed to understand where each one of the components fits into the landscape before we can start to understand the functionality, flexibility, and configuration of each As we mentioned, we will be looking at each of these components at a very high level and even though the configuration of the required source of data to each of these is critical, we will not be looking at items such as Universes or Data Federator in SAP BusinessObjects Yes, these are critical and in most cases required before we can build any of the reports from tools such as Web Intelligence or Xcelsius but the development and process of configuring a BusinessObjects Universe is for another book As a matter of fact, and you are probably tired of me pointing this out, but the configuration and development of the full set of these BusinessObjects reporting components would definitely fill another book So, we need to align each of these components based on their functionality and use, and then discuss some additional basic information around each component What we want to avoid, and what is the underlying point from the previous discussion, is that the implementers of the BOBJ project should be aware that they may be in a BI green field, and it can be useful to schedule a meeting with various stakeholders to discuss some common terms and approaches The last thing anyone wants is to find out deep in the project.