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traverses only the ventral root and can be elicited from any number of muscles The combination of a normal F response and an absent H re ex is found in diseases of sensory nerves and roots Both of these late responses nd their main use as corroborative tests that must be interpreted in the context of the entire nerve conduction examination (see Wilbourn in References) The normal late response latencies are given in Table 45-1 Blink Responses This special nerve conduction test is useful in the diagnosis of certain demyelinating neuropathies and in any process that affects the trigeminal or facial nerve The supraorbital (or infraorbital) nerve is stimulated transcutaneously and the re ex closure of both orbicularis oculi muscles is recorded with surface electrodes Two CMAP bursts are observed: the rst (R1) appears ipsilaterally 10 ms after the stimulus and the second (R2) ipsilaterally at 30 ms and contralaterally up to 5 ms later The amplitudes of the responses vary considerably and are not in themselves clinically important The rst response is not visible as a muscular contraction but may serve some preparatory function by shortening the blink re ex delay R1 is mediated by an oligosynaptic pontine circuit consisting of one to three neurons located in the vicinity of the main sensory nucleus; R2 utilizes a broader re ex pathway in the pons It has been established that R1 and R2 are generated by the same facial motor neurons The elicitation of blink re exes establishes the integrity of the afferent trigeminal nerve, the efferent facial nerve, and the interneurons in the pons (R1) and caudal medulla (related to the bilateral R2 response) The test may be also be helpful in identifying a demyelinating neuropathy when the facial and oropharyngeal muscles are affected and those of the limbs are relatively spared, leaving conventional nerve studies normal In such cases, the blink responses are delayed ipsilaterally and contralaterally as a result of conduction block in the proximal facial nerve Direct facial nerve stimulation often fails to demonstrate this block because only the distal segment of the nerve is amenable to study Although this test is rarely necessary for diagnosis, most patients with hereditary neuropathy have blink response abnormalities In Bell s palsy there is a delay or absence of R1 and R2 responses only on the affected side Large acoustic neuromas may interfere with the afferent trigeminal portion of the pathway and give rise to abnormal responses on the affected side Diseases of the brainstem have yielded inconsistent responses It is noteworthy that the test is normal in patients with trigeminal neuralgia Segmental Motor, Cranial, and Somatosensory Evoked Potentials (See also Chap 2) These techniques nd use in diseases that affect spinal roots By applying a magnetic stimulus, which induces an electrical impulse, or by a directly delivered electrical stimulus over the lower cervical or lumbar spine, it is possible to activate the motor (anterior) roots and to measure the time required to elicit a muscle contraction (Cros and Chiappa) These root stimulation tests can be quite uncomfortable for the patient because of the contraction of muscles surrounding the stimulation site Transcranial magnetic stimulation of the cerebral cortex permits measurement of the latency of muscle contraction after excitation of motor neurons in the cortex Thus, the integrity of the entire corticospinal system, from the cortical motor neurons through spinal tracts, anterior horn cells, and the peripheral motor nerve can be determined By combining this technique with the previously described root stimulation, it becomes possible to measure central and peripheral motor conduction times These forms.

As you can see, the properties include filters and parameters for Color, Texture, Style, and other background elements that can be configured Also notice that as you choose each of the different elements and its properties are displayed, the affected area is also highlighted in the Chart Designer chart preview An example of selecting the Columns element is shown in the following illustration

Special Electrodiagnostic Studies of Nerve Roots and Spinal Segments (Late Responses, Blink Responses, Segmental Evoked Responses)

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H Re ex Information about the conduction of impulses through the proximal segments of a nerve is provided by the study of the H re ex and the F wave In 1918, Hoffmann, after whom the H re ex was named, showed that submaximal stimulation of mixed motor-sensory nerves, insuf cient to produce a direct motor response, induces a muscle contraction (H wave) after a latency that is far longer than that of the direct motor response This re ex is based on the activation of afferent bers from muscle spindles (the same axons that conduct the afferent volley of the tendon re ex), and the long delay re ects the time required for the impulses to reach the spinal cord via the sensory bers, synapse with anterior horn cells, and to be transmitted along motor bers to the muscle (see Fig 3-1) Thus the H re ex is therefore the electrical representation of the tendon re ex circuit and is especially useful because the impulse traverses both the posterior and anterior spinal roots The H re ex is particularly helpful in the diagnosis of S1 radiculopathy and of other polyradiculopathies Its status generally parallels that of the Achilles re ex However, it may be dif cult to elicit an H re ex from nerves other than the tibial Stimuli of increasing frequency but low intensity cause a progressive depression and nally obliteration of H waves The latter phenomenon has been used to study spasticity, rigidity, and cerebellar ataxia, in which there are differences in the frequency-depression curves of H waves F Wave The F response, so named because it was initially elicited in the feet, was rst described by Magladery and McDougal in 1950 It is evoked by a supramaximal stimulus of a mixed motorsensory nerve After a latency longer than that for the direct motor response (latencies of 28 to 32 ms in arms, 40 to 50 ms in legs), a second small muscle action potential is recorded (F wave) The F wave is the result of the impulses that travel antidromically in motor bers to the anterior horn cells, a small number of which are activated and produce an orthodromic response that is recorded in a distal muscle The response is a more reliable test than the H wave of proximal nerve and root conduction in that the F wave.

jacent vessel, as suggested by Janetta, is still a controversial measure and probably better suited to the treatment of sustained and disabling but unexplained vertigo, as discussed further on, than to the treatment of classic Meniere disease The decision to under ` take any surgical procedure must be tempered by the fact that a majority of the patients, who are middle-aged, stabilize spontaneously in a few years

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ur focus in this book is advanced option trading strategy and how to utilize it effectively in high volatility It is important to make certain that you have the proper background on options in order to understand more advanced material later in the book With that in mind, let s do a quick review of the basics of what options are and how they function in the market