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cranial nerves as well The majority of these disorders are painful and are commonly associated with systemic disorders that produce constitutional or other symptoms indicative of non-neurological end-organ involvement These are most readily recognized by the sequential development of motor, sensory, and re ex de cits, which are segmental in their pattern and asymmetric and haphazard in their distribution Eventually, these de cits may become con uent and with their localization less recognizable unless the history can be recalled in a precise and chronological fashion The differential diagnosis of polyradiculopathy includes multifocal neuropathy (aka multiple mononeuropathies or mononeuritis multiplex), the other neurological localization that may produce a similar pattern of motor, sensory and re ex de cits affecting the lower extremities Multifocal neuropathies are discussed in s 1, 9, and 13 These are typically caused by disorders that infarct or in ltrate nerves or, alternatively, predispose them to compressive injury Cranial nerve de cits and pain and sensory symptoms affecting the trunk would favor the diagnosis of polyradiculopathy over multifocal neuropathy, although the clinical distinction is often dif cult Electrodiagnostic or CSF examinations are often required to resolve this diagnostic dilemma Disorders of the lower spinal cord parenchyma, ie, the conus medullaris syndrome, may produce motor and sensory de cits in the lower extremities, which appear segmental in nature, in addition to the common and often initial symptoms of bowel, bladder, and sexual dysfunction For the most part, unlike polyradiculopathy and multifocal neuropathy, signs and symptoms would be expected to remain con ned to the lower extremities and genitourinary function Etiologies of the conus medullaris syndrome usually differ from cauda equina syndrome Dural vascular malformations,39 42 and other causes of spinal cord infarction,43 primary spinal cord tumors such as ependymomas, syringomyelia,44 in ammatory spinal cord diseases such as multiple sclerosis,45 and infectious causes such as schistosomiasis46 may present in this fashion Polyradiculoneuropathies are disorders that appear to affect both nerve root and nerve trunk The acute (Guillain Barr syndrome) and chronic in ammatory e demyelinating polyradiculoneuropathies are the most common cause of this syndrome As the phenotype typically affects both upper and lower extremities in a symmetric fashion, the phenotype of polyradiculoneuropathy is more in keeping with that of a polyneuropathy than a polyradiculopathy and is therefore considered in more appropriate detail in s 11 and 12.

Arachnoiditis Degenerative Spondylosis (spinal stenosis) Central disk herniation Epidural lipomatosis Diabetes (polyradiculoplexus neuropathy) Iatrogenic (epidural and caudal anesthesia) Ischemic Dural vascular malformations Spinal cord infarction Nonsystemic vasculitic neuropathy Infectious CMV HIV (CMV, herpes simplex, syphilis, Cryptococcus, and atypical mycobacteria) Lyme disease Schistosomiasis Spinal epidural abscess In ammatory Sarcoidosis Neoplastic Meningitis Primary spinal cord tumors ependymomas, lipomas, dermoid, epidermoid, hemangioblastoma, paraganglioma, and ganglioneuroma Primary nerve sheath tumors neuro bromas and schwannomas Primary vertebral tumors cordomas, multiple myeloma, and osteoma Primary paravertebral tumors lymphomas Metastatic vertebral tumors breast, lung, and prostate Intravascular tumor lymphoma Osseous Paget disease In ammatory spondyloarthropathies, eg, ankylosing spondylitis Radiation

The potential etiologies of lumbosacral polyradiculopathy are more extensive than monoradiculopathy (Table 22 5)47 The more notable etiologies will be elab-

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As you learned in Lab Exercise 1201, the rst step in a successful Windows installation or upgrade is to determine whether your hardware meets the requirements of the new operating system Your rst stop in this process for any of the Microsoft offerings, including Windows Vista, should be the Microsoft support Web site Step 1 Start by visiting the home page for Windows Vista (wwwmicrosoftcom/windowsvista), shown in Figure 12-8 This page will evolve over time, so the exact options on the main screen may no longer be the ones I ve listed here; if this should be the case, you should be able to nd the information you need with a little searching Navigate through the screens and see if you can answer the following questions First, select the tab labeled The Experience and then answer these questions: How does Windows Vista enhance digital photography organization _______________________

orated on here Spondylosis producing the syndrome of spinal stenosis is the most common cause of lumbosacral polyradiculopathy, estimated to occur with a prevalence of 5 in every 1000 Americans over the age of 50 years28,34,48,49 This same syndrome may be produced by alternative mechanisms including central canal stenosis, which is congenital rather than acquired in nature Conversely, the syndrome may be created by a normal canal size with enlarged nerve elements This has been reported to occur with hypertrophic nerve roots in chronic in ammatory demyelinating polyneuropathy and Charcot Marie Tooth disease50 54 Large, midline disk herniations may produce an acute or subacute cauda equina syndrome but are relatively uncommon due to the protective nature of the posterior longitudinal ligament

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