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movement, to the point where the arm may strike the face This is due to a delay in contraction of the triceps muscle, which ordinarily would arrest over exion of the arm This abnormality, incorrectly referred to as Holmes s rebound phenomenon, is more appropriately designated as an impairment of the check re ex Stewart and Holmes, who rst described this test, made the point that when resistance to exion is suddenly removed, the normal limb moves only a short distance in exion and then recoils or rebounds in the opposite direction In this sense, rebound of the limb is actually de cient in cerebellar disease but is exaggerated in spastic states Patients with these various abnormalities of tone may show little or no impairment of motor power, indicating that the maintenance of posture involves more than the voluntary contraction of muscles It is noteworthy that most of the additional signs of cerebellar hypotonia are absent in the accid muscles of peripheral nerve disease indicating that the cerebellum exerts a unique modulating effect at spinal segmental levels Other Symptoms of Cerebellar Disease A slight loss of muscular power and excessive fatigability of muscle may occur with acute cerebellar lesions Also, in unilateral cerebellar disease, the ipsilateral arm may not swing normally in walking Insofar as these symptoms cannot be explained by other disturbances of motor function, they may be regarded as primary manifestations of cerebellar disease, but they are never severe or persistent and are of little clinical importance; anything approaching a hemiparesis in distribution or severity should not be attributed to cerebellar disease Myoclonic movements ie, brief (50- to 100-ms), random contractions of muscles or groups of muscles are, in some disease processes, combined with cerebellar ataxia When multiple jerks mar a volitional movement, they may be mistaken for an ataxic tremor (The same error may be caused by asterixis) Ramsey Hunt described myoclonus in connection with a rare heredodegenerative disease (see page 937), but it has also been observed in neuronal storage diseases of various kinds Action myoclonus may be the principal residual sign of hypoxic encephalopathy, as described on page 89, and it has been proposed that these conditions have a cerebellar origin Myoclonus is described more fully in Chap 6 More abstruse than the role of the cerebellum in motor control is the proposed participation of this structure in all manner of cognitive function and behavior (see the reviews by Leiner et al and by Schmahmann and Sherman) These authors and others have described a wide range of de cits of memory and cognition, language function, and behavior in patients with disease apparently limited to the cerebellum (as determined by computed tomography and magnetic resonance imaging) It is true that cerebellar lesions interfere with the establishment of conditioned re exes and perhaps some deterioration in certain learning tasks as detected by specialized tests To date, however, a uniform clinical pathologic syndrome in which a distinctive cognitive-behavioral de cit or group of de cits is related to a particular cerebellar lesion has not emerged, and the mechanisms by which discrete cerebellar lesions might in uence cognitive function remain uncertain.

(rate of development) and degree of permanence of the ataxia are of particular importance, as summarized in Table 5-1 Each of the major causes is discussed in an appropriate chapter In adults, paraneoplastic and demyelinating cases account for the largest proportion of cases of subacute onset, and hereditary forms are the usual cause of very slowly progressive and chronic ones, particularly if gait alone is affected The latter now constitute a large and heterogeneous group for which the genetic basis has been established in most cases; they are reviewed extensively in Chap 39 Unilateral ataxia without accompanying signs is most often Table 5-1 Diagnosis of generalized cerebellar ataxia

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Exadata Storage Server Software takes these advantages even further First of all, Exadata Smart Scan operations can be performed on encrypted data, allowing the benefits from these features to be used with encrypted data Second, the actual decryption of data can be performed on the CPUs in the Storage Server, eliminating virtually all the overhead required for this process from the workload of the database server Third, encryption works well with compression, which reduces the size of the data and correspondingly reduces the overhead of encrypting data Finally, as mentioned in the previous chapter, the Exadata Storage Server and X2-2 database nodes can offload decryption operations to hardware-based instructions in the Westmere chip The interaction between Exadata Storage Server Software and Transparent Data Encryption is a great illustration of the power of the complete Oracle solution A useful feature is not only supported by the advances of the Oracle Exadata Database Machine, but extended to allow the use of the feature with even better performance

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If a dot matrix printer produces blank pages, pay attention to the sound coming from the printer itself If you cannot hear the pins striking the page, try replacing the print head If the pins are striking the page but there is a blank printout, there is a ribbon problem First, check to ensure that the ribbon is lined up with the print head If the ribbon gets accidentally pulled above or below the print head, no image will be created on the page If the ribbon is already lined up properly, the ribbon is probably worn out, and you can resolve the problem by replacing the ribbon The distance between the print head and the paper can be adjusted in most dot matrix printers This is especially useful for printing multipart forms Experimenting with the head settings may also reestablish normal printing If an inkjet printer produces blank pages, the likely suspect is the ink cartridge Use the printer s software utility to determine the amount of ink left in the cartridge If no such utility came with the printer, remove the cartridge and gently rock it back and forth to determine if there is ink present If there is not, replace the cartridge If there is ink, the problem could be a clogged nozzle Follow the printer manufacturer s instructions for cleaning the print head/printer cartridge(s) with the provided software

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