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Lateral Medullary Syndrome below) If the subclavian artery is blocked proximal to the origin of the left vertebral artery, exercise of the arm on that side may draw blood from the right vertebral and basilar arteries, down the left vertebral and into the distal left subclavian artery sometimes resulting in the symptoms of basilar insuf ciency This phenomenon, described in 1961 by Reivich and colleagues, was referred to by Fisher as the subclavian steal Its most notable features are vertigo and sometimes other brainstem signs coupled with transient weakness on exercise of the left arm There may also be headache and claudication or pain of the arm Less often, occlusion of the vertebral artery or one of its medial branches produces an infarct that involves the medullary pyramid, the medial lemniscus, and the emergent hypoglossal bers; the resultant syndrome consists of a contralateral paralysis of arm and leg (with sparing of the face), contralateral loss of position and vibration sense, and ipsilateral paralysis and later atrophy of the tongue This is the medial medullary syndrome (Fig 34-13) A more limited lesion, from occlusion of one spinal artery arising from the vertebral artery, gives rise to a contralateral hemiplegia (rarely a quadriplegia) that spares the face When the vertebral branch to the anterior spinal artery is blocked, ow from the other (corresponding) branch is usually suf cient to prevent infarction of the cervical cord, but we and others have described pyramidal infarction with hemiplegia that spares the face Occlusion of a vertebral artery low in the neck is usually compensated by anastomotic ow to the upper part of the artery via the thyrocervical, deep cervical, and occipital arteries or re ux from the circle of Willis Lateral Medullary Syndrome Known also as the Wallenberg syndrome (who described a case in 1895), this common stroke is produced by infarction of a wedge of lateral medulla lying posterior to the inferior olivary nucleus (Fig 34-13) The complete syndrome, as outlined by Fisher and colleagues (1961), comprises involvement of the vestibular nuclei (vertigo, nystagmus, oscillopsia, vomiting); spinothalamic tract (contralateral or, less often, ipsilateral impairment of pain and thermal sense over half the body); descending sympathetic tract (ipsilateral Horner syndrome mio-.

features that also play a role in addressing the same issues as the Database Machine that deserve a brief explanation

Medial longitudinal fasciculus 12th N nucleus Medial lemniscus Tractus solitarius with nucleus Vestibular nucleus Restiform body Cerebellum

To create an ERD, access the Windows 2000 Backup utility and select Emergency Repair Disk from the Welcome tab It is important to note here that the ERD will contain information about the computer s current configuration If you use an ERD that was created with an older configuration, the repair utility might not function correctly For this reason, you should create a new ERD each time you change the configuration of the system

Nucleus ambiguus motor 9 + 10 Descending nucleus and tract-5th N Descending sympathetic tract Dorsal spinocerebellar tract 10th N Lateral medullary syndrome Ventral spinocerebellar tract Pyramid Medial medullary syndrome 12th N Spinothalamic tract Inferior olive

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Figure 34-13 Transverse section through the upper medulla (Continued on the facing page)

RING HA, SERRA-MESTRES J: Neuropsychiatry of the basal ganglia J Neurol Neurosurg Psychiatry 72:12, 2001 SEGAWA M, HOSAKA A, MIYAGAWA F, et al: Hereditary progressive dystonia with marked diurnal uctuation Adv Neurol 14:215, 1976 STANDAERT DG, YOUNG AB: Treatment of central nervous system degenerative disorders, in Goodman & Gilman s, The Pharmacological Basis of Therapeutics, 10th ed New York, McGraw Hill, 2001, pp 549 568 THACH WT JR, MONTGOMERY EB JR: Motor system, in Pearlman AL, Collins RC (eds): Neurobiology of Disease New York, Oxford University Press, 1992, pp 168 196 VAN WOERKOM W: La cirrhose hepatique avec alterations dans les centres nerveux evoluant chez des sujets d age moyen Nouv Iconogr Saltpetri ere 7:41, 1914 ` VERNINO S, TUITE P, ADLER CH, et al: Paraneoplastic chorea associated with CRMP-5 neuronal antibody and lung carcinoma Ann Neurol 51: 25, 2002 WATTS RL, KOLLER WC (eds): Movement Disorders: Neurologic Principles and Practice, 2nd ed New York, McGraw-Hill, 2004

WHITTIER JR, METTLER FA: Studies on the subthalamus of the rhesus monkey J Comp Neurol 90:281, 319, 1949 WICHMANN T, DELONG M: Physiology of the basal ganglia and pathophysiology of movement disorders of basal ganglia origin, in Watts RL, Koller WC (eds): Movement Disorders: Neurologic Principles and Practice, 2nd ed New York, McGraw-Hill, 2004, pp 101 112 WILSON SAK: Disorders of motility and of muscle tone, with special reference to corpus striatum: The Croonian Lectures Lancet 2:1, 53, 169, 215, 1925 WOOTEN GF, LOPES MBS, HARRIS WO, et al: Pallidoluysian atrophy: Dystonia and basal ganglia functional anatomy Neurology 43:1764, 1993 YANAGISAWA N, GOTO A: Dystonia musculorum deformans: Analysis with electromyography J Neurol Sci 13:39, 1971 YOUNG AB, PENNEY JB: Biochemical and functional organization of the basal ganglia, in Jankovic J, Tolosa ES: Parkinson s Disease and Movement Disorders, 3rd ed Baltimore, Lippincott, Williams & Wilkins, 1998, pp 1 11 ZEMAN W: Pathology of the torsion dystonias (dystonia musculorum deformans) Neurology 20:79, 1970

Windows XP introduced a new system recovery tool called Automated Systems Recovery that replaced the ERD process used in Windows 9x and Windows 2000 The ASR program is accessed through the Backup wizard To create an ASR disk, select Advanced, as shown in Figure 9-18, and then select the Automated System Recovery Preparation Wizard, as shown in Figure 9-19 The process creates a floppy disk that you can use to recover your system in the event of a systems failure In the event of a failure, boot the system from the floppy disk and you can begin repairing or reinstalling components of the operating system To use this process, you must also have a backup using the Windows backup program You can only recover from supported media of the backup program

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