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Stroke Type and Subtype Ischemic stroke Lacunar infarct Small (< 5 mm) lesions in the basal ganglia, pons, cerebellum, or internal capsule; less often in deep cerebral white matter; prognosis generally good; clinical features depend on location, but may worsen over first 24 36 hours See text signs vary depending on occluded vessel CT may reveal small hypodensity but is often normal Aspirin; long-term management is to control risk factors (hypertension and diabetes mellitus) Clinical Features Diagnosis Treatment

Noncontrast CT to exclude hemorrhage; CT may be normal during first 6 24 hours of an ischemic stroke, whereas diffusion-weighted MRI is more sensitive; electrocardiography, blood glucose, complete blood count, and tests for hypercoagulable states, hyperlipidemia are indicated; echocardiography or Holter monitoring in selected instances As for carotid circulation obstruction

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Solution to Exercise 19-1. We ll start things off simply. Create a WPF application with several Button and TextBox controls. Set the TextBox controls to have white text on a blue background, and the Button controls to have green text on a gray background. This exercise isn t particularly challenging, but it does enable you to practice the use of styles. You first create a new WPF project. Then drag several Button and TextBox controls onto the form; it doesn t matter where. You could certainly copy the same Style attributes to each control, but that s a pain. Instead, you should define a style resource for each control in the Windows.Resources section. Remember to give each style an x:Key property so that you can reference it later from within the controls, and remember to have each control reference the style as a StaticResource. Example A-56 shows the full XAML file for this exercise.

Select patients for intravenous thrombolytics or intra-arterial mechanical thrombolysis; aspirin (325 mg/d orally) combined with sustainedrelease dipyridamole (200 mg twice daily) is first-line therapy; anticoagulation with heparin for cardioembolic strokes, and sometimes for evolving stroke when no contraindications exist As for carotid circulation obstruction

See text signs vary based on location of occluded vessel Commonly associated with hypertension; also with bleeding disorders, amyloid angiopathy Location: basal ganglia more common than pons, thalamus, cerebellum, or cerebral white matter

Subroutine/function calls Like most programming languages, AppleScript supports function (subroutine) calls. Here is an example of how to use a subroutine call in AppleScript:3

Noncontrast CT is superior to MRI for detecting bleeds of < 48 hours duration; laboratory tests to identify bleeding disorder: angiography may be indicated to exclude aneurysm or AVM Do not perform lumbar puncture CT to confirm diagnosis, but may be normal in rare instances; if CT negative and suspicion high, perform lumbar puncture to look for red blood cells or xanthochromia; angiography to determine source of bleed in candidates for treatment CT indicates subarachnoid hemorrhage, and angiography then demonstrates aneurysms; angiography may not reveal aneurysm if vasospasm present

Example A-56. One solution to Exercise 19-1

Most managed supportively, but cerebellar bleeds or hematomas with gross mass effect benefit from urgent surgical evacuation

Atopic dermatitis looks different at different ages and in people of different races Because most patients have scaly dry skin at some point, this disease is being discussed under scaly dermatoses However, acute flares may present with red patches that are weepy, shiny, or lichenified (ie, thickened, with more prominent skin markings) and plaques and papules Diagnostic criteria for atopic dermatitis must include pruritus, typical morphology and distribution (flexural lichenification in adults), and a tendency toward chronic or chronically relapsing dermatitis Also helpful are (1) a personal or family history of atopic disease (asthma, allergic rhinitis, atopic dermatitis), (2) xerosisichthyosis, (3) facial pallor with infraorbital darkening, (4) elevated serum IgE, (5) fissures under the ear lobes, (6) a tendency toward nonspecific hand dermatitis, (7) a tendency toward repeated skin infections, and (8) nipple eczema

Treatment of melanoma consists of excision After histologic diagnosis, the area is usually reexcised with margins dictated by the thickness of the tumor Thin low-risk and intermediate-risk tumors require only conservative margins of 1 3 cm More specifically, surgical margins of 05 cm for melanoma in situ and 1 cm for lesions less than 1 mm in thickness are recommended Sentinel lymph node biopsy (selective lymphadenectomy) using preoperative lymphoscintigraphy and intraoperative lymphatic mapping is effective for staging melanoma patients with intermediate risk without clinical adenopathy and is recommended for all patients with lesions over 1 mm in thickness or with high-risk histologic features -Interferon and vaccine therapy may reduce recurrences in patients with high-risk melanomas Referral

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