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Numerous guides to the examination of the nervous system are available (see the references at the end of this chapter) For a full account of the methods, the reader is referred to the monographs of DeMyer, Ross, Mancall, Bickerstaff and Spillane, Glick, Haerer, and of the staff members of the Mayo Clinic, each of which approaches the subject from a somewhat different point of view An inordinately large number of tests of neurologic function have been devised, and it is not proposed to review all of them here Some are described in subsequent chapters dealing with disorders of mentation, cranial nerves, and motor, sensory, and autonomic functions Many tests are of doubtful value or are repetitions of simpler tests and should therefore not be taught to students of neurology Merely to perform all of them on one patient would require several hours and probably, in most instances, would not make the examiner any the wiser The danger with all clinical tests is to regard them as indisputable indicators of disease rather than as ways of uncovering disordered functioning of the nervous system The fol-

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The function of the cranial nerves must be investigated more fully in patients who have neurologic symptoms than in those who do not If one suspects a lesion in the anterior fossa, the sense of smell should be tested in each nostril; then it should be determined whether odors can be discriminated Visual elds should be outlined by confrontation testing, in some cases by testing each eye separately; if any abnormality is suspected, it should be checked on a perimeter and scotomas sought on the tangent screen or, more accurately, by computed perimetry Pupil size and reactivity to light and accommodation during convergence, the position of the eyelids, and the range of ocular movements should next be observed Details of these test procedures and their interpretation are given in Chaps 12, 13, and 14 Sensation over the face is tested with a pin and wisp of cotton; also, the presence or absence of the corneal re exes may be determined Facial movements should be observed as the patient speaks

Figure 4-3 Schematic illustration of major efferent and afferent connections of the basal ganglia (see text for details; also Fig 4-2) (Reproduced with permission from Kandel ER, Schwartz JH, Jessell TM: Principles of Neural Science, 4th ed New York: McGraw-Hill, 2000)

time was the central role of the ventrolateral and ventroanterior nuclei of the thalamus Together, they form a vital link in an ascending ber system, not only from the basal ganglia but also from the cerebellum to the motor and premotor cortex Thus both basal ganglionic and cerebellar in uences are brought to bear, via thalamocortical bers, on the corticospinal system and on other descending pathways from the cortex Direct descending pathways from the basal ganglia to the spinal cord are relatively insigni cant The foregoing view of basal ganglionic organization has been broadened considerably, the result of new anatomic, physiologic, and pharmacologic data (see in particular the reviews of Gombart, of Crutcher, of DeLong, and of Penney and Young) Whereas earlier concepts emphasized the serial connectivity of the basal

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Hash The partition key for hash partitions is created by running a hash function on the designated partition column The hash calculation is used to ensure an even distribution among partitions, even when the distribution of the actual values of the partition column is uneven A hash-partitioned table cannot use partition pruning when the selection criteria include a range of values Range Range partitioning uses the actual value of the partition key to create the partitions Range partitioning is described with a low value and a high value for the partition key, although you can have one partition without a low value for all values lower than the specific value and one partition without a high value for a similar function at the high end Range partitions can be used for partition pruning with a range of values, either specified or implied through the use of the LIKE operator List In a list partition, you assign a specific list of values for a partition key to indicate membership in a partition The list partition is designed for those situations where a group of values are linked without being consecutive, such as the states or territories in a sales region List partitions can be used for partition pruning with the LIKE operator Composite Composite partitioning is a way of adding a subpartition to a table, giving the table two levels of partitioning, as shown in Figure 2-9 Composite partitioning allows Oracle to go directly to a partition with specific values in two dimensions With Oracle Database 11g, you can have any mix of composite partitions that include range, hash, or list partitions Interval An interval partition is a way to reduce the maintenance overhead for range partitions that use a date or number as the partition key For an interval partition, you define the interval that specifies the boundaries of a partition The Oracle Database will subsequently create partitions as appropriate without any further intervention If the value for a partition key requires a new partition to be created, that operation is performed automatically You can.

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