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This chapter focused on ways to prevent computer problems and how to protect the computer, the environment, and yourself from harm One of the most effective ways to stop problems before they start is to clean the computer often Cleaning can prevent damage due to overheating, reverse the progression of a problem before it becomes noticeable, and give you a good chance to inspect the computer s internal components for signs of wear and tear Some components, such as plastic casings, can be cleaned with mild, soapy water Others, such as floppy drives or mouse rollers, require the use of isopropyl alcohol Always check with the manufacturer for proper cleaning instructions, and never use a liquid cleaner on a device for which it was not intended You can also help prevent computer problems by conditioning and smoothing out the power source By using a UPS, suppressor, and/or noise filter, you can remove or minimize problems caused by power outages, surges, or EMI Always be aware of potential environmental and personal hazards Always dispose of computer components properly You can check the component s MSDS for proper disposal instructions You should also be aware of components that use high voltage or lasers, such as the monitor, power supply, and CD-ROM drive Finally, handle components carefully when you store them Keep them out of hot or damp places, and keep magnetic storage devices away from EMI-emitting devices

Anosmia or Loss of the Sense of Smell (Table 12-1) This is the most frequent clinical abnormality, and, if unilateral, will not be recognized by the patient Unilateral anosmia can sometimes be demonstrated in the hysterical patient on the side of anesthesia, blindness, or deafness Bilateral anosmia, on the other hand, is a not uncommon complaint, and the patient is usually convinced that the sense of taste has been lost as well (ageusia) This calls attention to the fact that taste depends largely on the volatile particles in foods and beverages, which reach the olfactory receptors through the nasopharynx, and that the perception of avor is a combination of smell, taste, and tactile sensation This can be proved by demonstrating that such patients are able to distinguish the elementary taste sensations on the tongue (sweet, sour, bitter, and salty) The olfactory defect can be veri ed readily enough by presenting a series of nonirritating olfactory stimuli (vanilla, peanut butter, coffee, tobacco, etc), rst in one nostril, then in the other, and asking the patient to sniff and identify them If the odors can be detected and described, even if they cannot be named, it may be assumed that the olfactory nerves are relatively intact (humans can distinguish many more odors than they can identify by name) If they cannot be detected, there is an olfactory defect Ammonia and similar pungent substances are unsuitable stimuli because they do not

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test the sense of smell but have a primary irritating effect on the mucosal free nerve endings of the trigeminal nerves A more elaborate scratch-and-sniff test has been developed and standardized by Doty and colleagues (University of Pennsylvania Smell Identi cation Test) In this test the patient attempts to identify 40 microencapsulated odorants and his or her olfactory performance is compared with that of age- and sex-matched normal individuals Unique features of this test are a means for detecting malingering and amenability to self-administration Air-dilution olfactory detection is a more re ned way of determining thresholds of sensation and of demonstrating normal olfactory perception in the absence of odor identi cation The use of olfactory evoked potentials is being investigated in some electrophysiology laboratories, but their reliability is uncertain These re ned techniques are essentially research tools and are not used in neurologic practice The loss of smell usually falls into one of three categories: nasal (in which odorants do not reach the olfactory receptors), olfactory neuroepithelial (due to destruction of receptors or their axon laments), and central (olfactory pathway lesions) In an analysis of 4000 cases of anosmia from specialized clinics, Hendriks found that three categories of pathology viral infection of the upper respiratory tracts (the largest group), nasal or paranasal sinus disease, and head injury accounted for most of the cases Regarding the nasal diseases responsible for bilateral hyposmia or anosmia, the most frequent are those in which hypertrophy and hyperemia of the nasal mucosa prevent olfactory stimuli from reaching the receptor cells Heavy smoking is probably the most frequent cause of hyposmia in clinical practice Chronic atrophic rhinitis; sinusitis of allergic, vasomotor, or infective types; nasal polyposis; and overuse of topical vasocontrictors are other common causes Biopsies of the olfactory mucosa in cases of allergic rhinitis have shown that the sensory epithelial cells are still present, but their cilia are deformed and shortened and are buried under other mucosal cells In uenza, herpes simplex, and hepatitis virus infections may be followed by hyposmia or anosmia due to destruction of receptor cells; if the basal cells are also destroyed, this may be.

For a long time, plain lms of the cranium constituted a routine part of the study of the neurologic patient, but it is evident that the yield of useful information from this procedure is relatively small Even in patients with head injury, where radiography of the skull would seem to be an optimal method of examination, a fracture is found in only 1 of 16 cases, at a cost of thousands of dollars per fracture and a small risk from radiation exposure Nevertheless plain skull lms are useful in demonstrating fractures, changes in contour of the skull, bony erosions and hyperostoses, infection in paranasal sinuses and mastoids, and changes in the basal foramina Plain lms of the spine are able to demonstrate destructive lesions of vertebrae, both neoplastic and infectious, fracture-dislocations, and Paget disease Sequential re nements of radiologic technique have greatly increased the yield of valuable information in special cases, but without question the most important recent advances in neuroradiology, and indeed in neurology, have come about with the development of CT and MRI They represent a quantum leap in our ability to visualize pathology in the living person

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