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Hysterical paralysis may involve one arm or leg, both legs, or all of one side of the body Tendon re exes are retained and atrophy is lacking in hysterical paralysis, features that distinguish it from chronic lower motor neuron disease Diagnostic dif culty arises only in certain acute cases of upper motor neuron disease that lack the usual changes in re exes and muscle tone The hysterical gait is often diagnostic (page 107) Sometimes there is loss of sensation in the paralyzed parts and loss of sight, hearing, and smell on the paralyzed side a pattern of sensory changes that is never seen in organic disease of the nervous system When the hysterical patient is asked to move the affected limbs, the movements tend to be slow, hesitant, and jerky, often with contraction of agonist and antagonist muscles simultaneously and intermittently ( give-way weakness) Lack of effort is usually obvious, despite facial and other expressions to the contrary Power of contraction improves with encouragement The weakness is inconsistent; some movements are performed tentatively and moments later another movement involving the same muscles is performed naturally Hoover s sign and the trunk-thigh sign of Babinski are helpful in distinguishing hysterical from organic hemiplegia To elicit Hoover s sign, the examiner places both hands under the heels of the recumbent patient, who is asked to press the heels down forcefully With organic hemiplegia, downward pressure will be felt from the nonparalyzed leg The examiner then removes his hand from under the nonparalyzed leg, places it on top of the nonparalyzed one, and asks the patient to raise that leg In true hemiplegia, no added pressure will be felt by the hand that remained beneath the heel of the paralyzed leg In hysteria, the heel of the supposedly paralyzed leg may press down on the examiner s hand Or, more useful in our experience, the normal leg fails to demonstrate downward pressure when the hysteric is asked to elevate the supposedly paralyzed one, thereby indicating a lack of voluntary effort To carry out Babinski s trunkthigh test, the examiner asks the recumbent patient to sit up while.

Objects that have been created with the new toolset cannot be further maintained with the BW 3x toolset In this case, SAP needs to supply this component (3x functionality to run BEx Reports) to support customers that continue to use and maintain their existing reporting objects The actual migration process for a reporting object takes place when a BW 3x reporting object is opened using the relevant new BI tool and then saved The details of the migration process are specific to the type of reporting object to be migrated A summary of some important information follows:

This condition usually indicates a lesion of one or more peripheral nerves or of several adjacent spinal roots The diagnosis of an in-

keeping his arms crossed in front of his chest In the patient with organic hemiplegia, there is an involuntary exion of the paretic lower limb; in paraplegia, both limbs are exed as the trunk is exed; in hysterical hemiplegia, only the normal leg may be exed; and in hysterical paraplegia, neither leg is exed

A discussion of motor paralysis would not be complete without some reference to a group of diseases in which muscle weakness may be profound but there are no overt structural changes in motor

nerve cells or nerve bers Almost any disease of the neuromus cular junction and many diseases of muscle may cause this combination This group comprises myasthenia gravis; in ammatory myopathies, the muscular dystrophies, and myotonia congenita (Thomsen disease); familial periodic paralysis; disorders of potassium, sodium, calcium, and magnesium metabolism; tetany; tetanus; poisoning by Clostridium botulinum; black widow spider bite; and the thyroid and other endocrine myopathies In these diseases, each with a fairly distinctive clinical picture, the abnormality is essentially biochemical; their investigation requires special biochemical and histochemical tests and electron microscopic study These subjects are discussed in the sections on muscle disease later in this book

Designer without further manual adaptation Therefore, you can open any BW 3x reports in the Query Designer in the 70 version without any additional configuration 3x component, and this includes the 3x BEx Query Designer

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