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A package of Husky Hound uses 2 pounds of cereal and 1 pound of meat, and sells for $6 Raw cereal costs $1 per pound and raw meat costs $2 per pound It also costs $140 to package the Frisky Pup and $060 to package the Husky Hound A total of 240,000 pounds of cereal and 180,000 pounds of meat are available each month The only production bottleneck is that the factory can only package 110,000 bags of Frisky Pup per month Needless to say, management would like to maximize pro t (a) Formulate the problem as a linear program in two variables..

But while this group of symptoms is often seen in the advanced stages of the disease, most neurologists would agree that it is not a common mode of presentation The most severe forms of cerebellar ataxia, in which the slightest attempt to move the trunk or limbs precipitates a violent and uncontrollable ataxic tremor, are observed among patients with long-standing MS The responsible lesion probably lies in the tegmentum of the midbrain and involves the dentatorubrothalamic tracts and adjacent structures Cerebellar ataxia may be combined with sensory ataxia, owing to involvement of the posterior columns of the spinal cord or medial lemnisci of the brainstem In most cases of this type the signs of spinal cord involvement ultimately predominate; in others, the cerebellar signs are more prominent Diplopia is another common presenting complaint.

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It is due most often to involvement of the medial longitudinal fasciculi, producing an internuclear ophthalmoplegia (see page 236) The signs are characterized by paresis of the medial rectus on attempted lateral gaze, with a coarse nystagmus in the abducting eye; in MS, this abnormality is usually bilateral (unlike small pontine infarcts, which cause a unilateral internuclear ophthalmoplegia) As a corollary, the presence of bilateral internuclear ophthalmoplegia in a young adult is virtually diagnostic of MS Occasionally, internuclear ophthalmoplegia in one direction is combined with a horizontal gaze paresis in the other, although this one-and-a-half syndrome is more typical of brainstem stroke (see also page 236) Other palsies of gaze (due to interruption of supranuclear connections) or palsies of individual ocular muscles (due to involvement of the ocular motor nerves in their intramedullary course) also occur, but less frequently.

One of the most remarkable cases in our experience was a middle-aged nurse who became distractible and ineffective at work and was thought for many months to be simply depressed Often it is observed that drowsiness, ocular palsies, diabetes insipidus, and disturbance of temperature regulation (indicating hypothalamic involvement) occur later Spontaneous rupture of the cystic lesion can incite a severe aseptic meningitis, at times with depressed glucose in the CSF In the differential diagnosis of the several craniopharyngioma syndromes, a careful clinical analysis is more informative than laboratory procedures Among the latter, MRI is likely to give the most useful information Often, because of the cholesterol content, the tumor gives an increased signal on T1-weighted images Usually, the cyst itself is isointense, like CSF, but occasionally it may give a decreased T2 signal.

Additional manifestations of brainstem involvement include myokymia or paralysis of facial muscles, deafness, tinnitus, unformed auditory hallucinations (because of.

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Answer 22-3

Oculomotor palsy with crossed hemiplegia Oculomotor palsy with contralateral cerebellar ataxia and tremor Oculomotor palsy with contralateral cerebellar ataxia, tremor, and corticospinal signs Ocular palsies, paralysis of gaze, and cerebellar ataxia Paralysis of upward gaze and accommodation; xed pupils

If we examine the conditions in a fine-grained security profile, we can identify a set of DBV factors we ll need to develop by asking: How is each fact in the condition asserted or defined We can add an extra column to Table 6-1 for the factors we can derive from these conditions.

Treatment Modern microsurgical techniques, reinforced by corticosteroid therapy before and after surgery and careful control of temperature and water balance postoperatively permit successful excision of all or part of the tumor in the majority of cases While smaller tumors can be removed by a transsphenoidal approach, attempts at total removal require craniotomy and remain a challenge because of frequent adherence of the mass to surrounding structures (Fahlsbusch et al) Partial removal practically assures recurrence of the tumor mass, usually within 3 years, and the surgical risks of reoperation are considerable (10 percent mortality in large series) In 21 of our 35 patients, only partial removal was possible; of these, 8 died, most in the rst postoperative year Stereotaxic aspiration is sometimes a useful palliative procedure, as are focused radiation therapy and ventricular shunting in patients with solid, nonresectable tumors.

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