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Nystagmus that occurs only in the abducting eye is referred to as dissociated nystagmus and is a common sign of internuclear ophthalmoplegia, as discussed above Pendular Nystagmus This is found in a variety of conditions in which central vision is lost early in life, such as albinism and various other diseases of the retina and refractive media (congenital ocular nystagmus) Occasionally it is observed as a congenital abnormality, even without poor vision The defect is postulated to be an instability of smooth pursuit or gaze-holding mechanisms The nystagmus is always binocular and in one plane; ie, it will remain horizontal even during vertical movement It is purely or mainly pendular (sinusoidal) except in extremes of gaze, when it comes to resemble jerk nystagmus Head oscillation may accompany the nystagmus and is probably compensatory.

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The formerly common syndrome of miner s nystagmus is an associated condition that occurs in patients who have worked for many years in comparative darkness The oscillations of the eyes are usually very rapid, increase on upward gaze, and may be associated with compensatory oscillations of the head and intolerance of light Indications as to the congenital nature of nystagmus are that it remains horizontal in all directions of gaze; it is suppressed during convergence and may be associated with odd head positions or with head oscillations and with strabismus Also characteristic is a paradoxical response to optokinetic testing (see below), in which the quick phase is in the same direction as the drum rotation A related latent nystagmus is the result of a lack of normal development of stereoscopic vision and may be detected by noting that.

Table 12-1.

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Figure 2-5. Short-latency brainstem auditory evoked responses (BAERs). Diagram of the proposed electrophysiologic-anatomic correlations in human subjects. Waves I through V are the ones measured in clinical practice.

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For optimal results, it is important for physicians and patients to understand the indications for noninvasive skin tightening. Such tightening is most likely to be successful for young to middle-aged patients with mild to moderate skin laxity. Anatomic areas that may be responsive include the jowls, brows, nasolabial folds and midface, neck, and abdomen. Reasonable patient expectations are important since tightening devices offer the possibility of modest improvement but seldom result in the dramatic improvement of a home-run. Energybased tightening is best for patients who de nitely do not want a face-lift but would be satis ed with modest, safe tightening if such were attainable. There are few absolute contraindications to noninvasive tightening, but some exclusion criteria are generally observed. Patients who expect the same degree of improvement from noninvasive skin tightening as is possible with a face-lift will likely be disappointed by even the maximal result obtained; hence, such patients should be excluded. Similarly, patients who are not prepared to be

Inducible: Genes turned on by the presence of a substrate for a catabolic (degradative) pathway. Repressible: Genes turned off by the presence of a product of a biosynthetic pathway. Positive regulators (enhancers): Turn on transcription when a specific effector protein binds to a specific enhancer sequence in the DNA. Negative regulators (repressors): Turn off transcription when a specific effector protein binds to a specific repressor sequence in the DNA.

Strangulation of nerve between herniating tissue and medial petroclinoid ligament; stretching of nerve over clivus from lateral displacement of midbrain; entrapment of nerve between posterior cerebral and superior cerebellar arteries from downward displacement of midbrain Pressure of laterally displaced midbrain against sharp edge of tentorium Crushing of midbrain between herniating temporal lobe and opposite leaf of tentorium and vascular occlusion (hemorrhages around arterioles and veins)

Two lpes of syslems thot ccn be modeledusinglineorolgebrclcequotions. lumpedvorioble (ol system thot involves coupled linitecomponents ond (b) distributed vcrioble system lhot involves o confinuum.

RANGE KEY ROUND ROBIN TABLE 2-2.

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