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inates in the occluded vessel but then proceeds to lodge in the posterior cerebral artery or the top of the basilar artery In most of the cases of this nature that we have observed, there are additional telltale signs of slight pontine strokes (dysarthria, diplopia, see page 702), presumably from the transient occlusion of the mouths of several small penetrating arteries as the embolus moves upward ( stop-and-go or traveling embolus syndrome) Arterial thrombosis is not usually accompanied by headache, but lateralized cranial pain occurs in some cases Usually the pain is located on one side of the head in carotid occlusion, at the back of the head, or simultaneously in forehead and occiput in basilar occlusion, and behind the ipsilateral ear or above the eyebrow in vertebral occlusion The headache is less severe and more regional than that of intracerebral or subarachnoid hemorrhage, and there is no stiffness of the neck The mechanism is unclear; presumably it is related to the disease process or distention of the vessel wall, since it may antedate the other manifestations of the stroke by days or even weeks As mentioned in the introductory section, hypertension is more often present than not in patients with atherothrombotic infarction Diabetes mellitus is common also, or the patient is a smoker or hyperlipidemic Often there is evidence of vascular disease in other parts of the body: a history of coronary occlusion or angina pectoris, an electrocardiographic (ECG) abnormality re ecting a previous myocardial infarction or left ventricular hypertrophy, intermittent claudication, or an absence of one or several pulses in the lower limbs The retinal arteries may show uniform or focal narrowing, increase and irregularity of the light re ex, and arteriovenous nicking, but these ndings correlate with hypertension rather than atherosclerosis The patient is more often elderly but may be in the fourth decade of life or even younger Laboratory Findings These have been discussed at various points in the preceding pages and need only be recapitulated brie y In the laboratory investigation of atherothrombotic infarction, one may employ noninvasive techniques Ultrasonography will reveal with fair accuracy the cervical and intracranial segments of the internal carotid and vertebrobasilar arteries MRI is more sensitive to ischemic brain damage than is the CT scan While the latter reveals hemorrhage immediately after it occurs, softened tissue cannot be seen until several days have elapsed On the other hand, MRI reveals ischemic damage within a few hours, in both white and gray matter, and diffusion-weighted MRI techniques do so even earlier The various MRI sequences are able to distinguish with reasonable clarity the age of cerebral infarction; the features that signify acute, subacute, and older strokes are summarized in Table 34-6 and discussed in Chap 2 By MRA, one can see all the major cervical and intracranial arteries and may detect the irregular lumen or occlusion of atherosclerosis and even embolic occlusions in more distal vessels (Fig 34-17) This method has to a large extent replaced conventional angiography, which is reserved for cases in which the diagnosis is in doubt (eg, suspected angiitis) or when surgical intervention or long-term anticoagulant therapy is contemplated Lumbar puncture is now performed infrequently in patients with stroke Cerebral thrombosis does not cause blood to enter the CSF The CSF protein is sometimes slightly elevated (usually 50 to 80 mg/dL); rarely is it in excess of 100 mg/dL A small number of polymorphonuclear leukocytes (3 to 8/mm3) is not exceptional in the rst few days; very rarely, and for unexplained reasons, a brisk, transient pleocytosis (400 to 1000 polymorphonuclear leu-.

The Win32::ODBC module comes as part of the standard ActivePerl distribution, and like DBI, it supports a generic interface for accessing databases, providing those databases are accessible through the ODBC system ODBC, open database connectivity, is a standard now followed by all the major database players, including IBM, Oracle, and Microsoft Both DBI and ODBC work in essentially the same manner, supporting a single API to the database The difference is in where the interface sits within the connectivity model Under DBI, the DBI module talks to a DBD driver that in turn communicates with the database We re therefore using the RDBMS libraries to access the database; we re just doing it through DBI ODBC, however, is an API that sits within the RDBMS; we just use a library to talk using ODBC protocols to the ODBC driver supplied by the database vendor When communicating with a database over a network, the DBD and the database API that supports it must have network connectivity The ODBC, on the other hand, includes a network communication layer, so I can talk to an ODBC-compliant database over a network through the ODBC system, whether that data source supports network connectivity or not With DBI, I can talk to any database that has had a DBD written for it and to any networked database that has network ability; with ODBC, I can communicate with any ODBC-compliant database over a network Under Windows, ODBC connectivity is a standard part of the operating system if I install an ODBC-capable application, then a driver is installed and I can access that data source from any ODBC client For example, if I install Microsoft Office, ODBC interfaces are installed for CSV, Excel spreadsheets, and Access databases Now from within Excel, I can run queries on flat files, excel spreadsheets, or Access databases I can do the same from Perl too If I were using DBI, I d need a DBD to access those sources In reality, DBI supports CSV databases, and an ODBC DBD exists to communicate with any ODBC-compliant source The other point at which the two differ is in the extended support The DBI toolkit explicitly works on a relatively basic level, providing the necessary interface for communicating with the database and executing queries The Win32::ODBC toolkit is a complete API to the ODBC system, including the ability to control the operation and default data handling of a suitable database This level of ODBC support is likely to be incorporated into DBI in due course, but for now, if you want to exercise a significant level of control over a Windows RDBMS, especially SQL Server, you d be better off with Win32::ODBC.

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T2-weighted Proton (spin) Density Fluid-attenuated inversion recovery (FLAIR) Diffusion-weighted image (DWI) Susceptibility sequence Short tau inversion recovery (STIR)

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