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Throughout this Report a range of recommendations are made with regard to spasms meaning purchase genuine sumatriptan online the education of the child muscle relaxant hiccups order sumatriptan 50mg without prescription. A critical issue to muscle relaxant radiolab generic 50mg sumatriptan with mastercard be addressed throughout the child’s educational progression from one level to infantile spasms 2013 buy sumatriptan online another, or from one type of school or setting to another, is that of continuity. The Visiting Teacher Service was established in the Department of Education and Science in 1972. Originally it catered only for children with hearing impairment and visual impairment but was extended subsequently to include some additional disabilities. Currently it is managed by the Inspectorate of the Department of Education and Science. The Visiting Teacher Service for Children with Certain Disabilities consists of forty-two teachers who are based throughout the country, each with responsibility for a disability category or categories in an agreed geographic area. Each of the Visiting Teachers has undergone basic teacher training and has received additional training and development in his/her particular area of responsibility. The role of the Visiting Teacher can vary somewhat, depending on the disability, the level of need and the requirements of the family. A particular feature of the service is the degree of flexibility which exists in the organisation of the service in each particular case. This means that the service can always be designed to meet the particular requirements of the pupil/student and his/her family. At present, when a child is diagnosed with a relevant disability, the case is immediately referred to the Visiting Teacher Service. From that point onwards the Visiting Teacher is available as a support to the family. He/she counsels the family and, in the case of deaf children, advises on the management of equipment and on the development of language and communication skills. The Visiting Teacher may also becomes involved in direct teaching of the child, as appropriate, even from an early age. However, the main purpose of such interaction with a very young child may be to support and guide the parents in their management and promotion of their child’s learning and communication and in the their support of the work of the school or pre-school in question. In 22 addition the Visiting Teacher discusses with the parents the other supports available and makes them aware also of the range of educational options available at any time and advises on appropriate action in this regard. The involvement of the Visiting Teacher normally continues throughout the career of the child in mainstream education, including pre-school. The Visiting Teacher continues, in agreement with the parents, to visit the child at home and at school on a regular basis, providing advice and guidance on the education of the child and providing an important link between the school and the home. As well as providing support of this kind to parents, the continuing role of the Visiting Teacher, both at home and at school, includes advice on appropriate educational objectives and on the evaluation of progress. It also continues to involve direct tuition as necessary, in agreement with the parents and in close consultation and co-operation with the mainstream teacher and other support teachers (such as the learning-support or resource teacher). As part of his/her role the Visiting Teacher also liaises with professionals and with other agencies, as necessary. In terms of interfacing with other special educational services, particularly as the child moves into different settings, the underlying approach is that the Visiting Teacher remains as available as is necessary. For example, if a deaf child goes to a special school for children with such disabilities then the role of the Visiting Teacher decreases, on the assumption that there is a high level of expertise in that special setting and also on the assumption that there is a high level of home/school contact already in place as part of the overall plan of such a school. If, on the other hand, the distance from the home to the educational placement (perhaps residential), or other circumstances, were to demand it, then the Visiting Teacher’s role could continue to be an important link. The Task Force regards the role described above as having real relevance for children with autism, particularly in the early years. Such a service could then dove-tail with the other support/advisory services that would come on stream as the child advances through the system. Please refer to chapter 3 which outlines the Task Force’s suggestions to strengthen the partnership between parents and schools. On those occasions where a consensus cannot be reached at the ground level, a formal, independent, incremental system of appeal must be developed (see Chapters 4 and 14). When needed, parents should be provided with an advocate to assist them through the procedure, or upon their request, represent their interests. There are a number of school systems in the United States, England and Northern Ireland that have developed such procedures. These should be investigated by the Department of Education and Science in their development of a comprehensive appeals process. This could take the form of informational material and a list of persons they could access for advice and to secure the entitlements for the child, approval of school level administrative support, etc. This would include curriculum guides, information on the disorder, academic material, social training programmes, community resources, integration options, web sites, etc. Particular reference to the formal Statementing process and development of Individual Educational Plans will create the need for significant training for the general school body (see Chapter 12 on Staff Education). Responsibility for insuring all of the above, would lie with the Special Needs Organisors which have been recommended by the Department of Education and Science Report of the Planning Group: A National Support Service for Special Education for Students with Disabilities (2000), which recommendation is supported by the Task Force. The ensuing research activity would focus on the issues raised in this Task Force Report. The first is each child’s entitlement to a curriculum suited to his/her needs and abilities and how the child can gain access to that curriculum. As well as attracting a good deal of comment, several academic and technical papers were submitted. Numerous submissions emphasised the importance and outcome of methods of Applied Behaviour Analysis, with some parents requesting this and others stating their satisfaction with this approach. The principle of inclusion was also prominent, together with the principle of making provision in the least restrictive environment. Others requested provision for their children to be with others of similar age and ability. The various placement options will be presented for early, primary and secondary levels, chapters 7, 8 and 9. The Task Force on Autism agrees with the concept that: the diagnosis of autism does not and should not lead to a specific set of educational strategies (Strain, et al, 1998). The Task Force also advocates that the specialist approach or approaches be based on the student’s current presentation. Thus there may be times or conditions under which a singular, selective approach may be exclusively or almost exclusively used with a child, and others when a combination of approaches will be preferred. The Task Force supports the objective of the Education Act (section 6F) to ‘promote best practice in teaching methods with regards to the diverse needs of the students and the development of the skills and competence of the teachers’. Many are supported through anecdotal reports, few through controlled research studies. Interested readers are encouraged to access relevant publications and training workshops to become fully informed on any one approach. A recent study by Mudford and colleagues (2000) demonstrated that a placebo condition of wearing headphones alone was just as effective. The child may spend months or years in the designated room, without interacting with the ‘outside world’ which is perceived as a cause of distress. Some parents find that the removal of gluten and casein, such as wheat and dairy products, from the diet can improve symptoms of Autism, but further research is urgently required. There are no satisfactory published results, however benefits may be expected due to the high degree of structure, long hours and strong physical sensory input. These include: • the Miller Method, a cognitive-developmental systems approach emphasising body organisation, social and communication issues; • Functional Developmental Individual Difference Relationship-Based Approach, Stanley Greenspan, M. This is based on following the child’s lead, semi structuring designated problem-solving interactions, and sensory/motor/spatial activities. It targets interpersonal interaction (emotional versus cognitive development) and integrated developmental skills. The children received 15-40 hours of programming weekly, and found that though not directly comparable due to varying approaches and philosophical differences: all of the programs were quite effective in fostering positive school placements, significant developmental gains, or both for a substantial percentage of their students. Of the six programs that reported placement data, four reported that approximately 50% of children were able to be integrated into a general classroom by the end of the intervention. This approach has been in use for nearly 30 years with very young children with autistic disorder. There are a significant number of published studies, more so than any other approach, following experimental designs, which support positive outcome (Lovaas 1987; Kazdin 1993; Koegel & Frea 1993; McEachin et al 1993). Based on an assessment of current skills, numerous systematic instructional sequences, are presented to the child, with correct trials resulting in positive reinforcement. Progress is very closely monitored through recording of the child’s reaction on each trial throughout the day, and then graphed for reference as to when to move on or modify procedures.
Before leaving the anim al facility muscle relaxant robaxin order sumatriptan 25 mg mastercard, scrub suits and uniforms are removed and appropriately contained and decontaminated prior to spasms meaning in telugu purchase 25mg sumatriptan overnight delivery laundering or disposal spasms near temple generic sumatriptan 50mg free shipping. Personal protective equipment is used for all activities involving manipulations of infectious material or infected animals muscle relaxant eperisone hydrochloride generic sumatriptan 25mg free shipping. Gloves are removed aseptically and autoclaved with other animal room wastes before disposal. Boots, shoe covers, or other protective footwear, and disinfectant foot baths are available and used where indicated. The risk of infectious aerosols from infected animals or their bedding also can be reduced if animals are housed in containment caging systems, such as open cages placed in inward flow ventilated enclosures. Biological safety cabinets and other physical containment devices are used whenever conducting procedures with a potential for creating aerosols. These include necropsy of infected animals, harvesting of tissues or fluids from infected animals or eggs, or intranasal inoculation of animals. This exterior entry door may be controlled by a key lock, card key, or proximity reader. Entry into the animal room is via a double-door entry which may include a change room and shower(s). An additional double-door access (air-lock) or double-doored autoclave may be provided for movement of supplies and wastes into and out of the facility, respectively. Doors to cubicles inside an animal room may open outward or slide horizontally or vertically. The animal facility is designed, constructed, and maintained to facilitate cleaning and housekeeping. Penetrations in floors, walls and ceiling surfaces are sealed and openings around ducts and the spaces between doors and frames are capable of being sealed to facilitate decontamination. A hands-free or automatically operated hand washing sink is provided in each anim al room near the exit door. If floor drains are provided, they are always filled with an appropriate disinfectant. Ventilation should be provided in accordance with criteria from the Guide for Care and Use of Laboratory Animals, latest edition. This system creates directional airflow which draws air into the laboratory from “clean” areas and toward “contaminated” areas. Filtration and other treatments of the exhaust air may not be required, but should be considered based on site requirements, and specific agent manipulations and use conditions. Personnel must verify that the direction of the airflow (into the anim al areas) is proper. It is recommended that a visual monitoring device that indicates and confirms directional inward airflow be provided at the animal room entry. An autoclave is available which is convenient to the animal rooms where the biohazard is contained. The autoclave is utilized to decontaminate infectious waste before moving it to other areas of the facility. Illumination is adequate for all activities, avoiding reflections and glare that could impede vision. The completed Biosafety Level 3 facility design and operational procedures must be documented. The facility must be tested for verification that the design and operational parameters have been met prior to operation. Facilities should be re-verified at least annually against these procedures as modified by operational experience. The laboratory or animal facility director limits access to the animal room to the fewest individuals possible. Personnel who must enter the room for program or 70 Vertebrate Animal Biosafety Level Criteria — Animal Biosafety Level 4 service purposes when work is in progress are advised of the potential hazard. This program must include appropriate immunizations, serum collection, and availability of post-exposure counseling and potential 10, prophylaxis. In general, persons who may be at increased risk of acquiring infection, or for whom infection might have serious consequences, are not allowed in the animal facility unless special procedures can eliminate the extra risk. Personnel are advised of special hazards, and are required to read and to follow instructions on practices and procedures. Equipment and work surfaces in the room are routinely decontaminated with an appropriate disinfectant after work with the infectious agent, and especially after overt spills, splashes, or other contamination by infectious materials. Spills and accidents that result in overt exposures to infectious materials must be immediately reported to the facility director. Medical evaluation, surveillance, and treatment 71 Vertebrate Animal Biosafety Level Criteria — Animal Biosafety Level 4 are provided as appropriate and written records are maintained. All wastes (including animal tissues, carcasses, and contaminated bedding), other materials for disposal, and clothing to be laundered, are sterilized in a double-door autoclave located in the secondary barrier wall of the facility (see B-4 below). Needles and syringes or other sharp instruments are restricted in the animal facility for use only when there is no alternative, such as for parenteral injection, blood collection, or aspiration of fluids from laboratory animals and diaphragm bottles. Syringes that re-sheathe the needle, needle-less systems, and other safe devices should be used when appropriate. A biohazard sign must be posted on the entrance to the animal room whenever infectious agents are present. The hazard warning sign identifies the infectious agent(s) in use, lists the name and telephone number of the responsible person(s), and indicates the special requirements for entering the animal room. Laboratory personnel receive appropriate training on the potential hazards associated with the work involved, the necessary precautions to prevent exposures, and the exposure evaluation procedures. Personnel receive annual updates, or additional training as necessary for procedural or policy changes. Cages are autoclaved or thoroughly decontaminated before bedding is removed and before they are cleaned 72 Vertebrate Animal Biosafety Level Criteria — Animal Biosafety Level 4 and washed. Equipment and work surfaces are routinely decontaminated with an appropriate disinfectant after work with infectious materials, and especially after spills, splashes, or other contam ination by infectious materials. Equipment must be decontaminated according to any local, state, or federal regulations before removal from the facility for repair or maintenance. Based on the risk assessment (see Section V), use of squeeze cages, working only with anesthetized animals, or other appropriate procedures to reduce possible worker exposure must be instituted. Personnel enter and leave the facility only through the clothing change and shower rooms. Personnel should not enter or leave the facility through the air locks, except in an em ergency. Complete laboratory clothing, including undergarments, pants and shirts or jump suits, shoes, and gloves, is provided and used by personnel entering the facility. When exiting, personnel remove laboratory clothing in the inner change room before entering the shower area. Supplies and m aterials are introduced into the facility via a double-door autoclave or fumigation chamber. After the outer door is secure, personnel inside the facility open the inner door to retrieve the materials. The doors of the autoclave and fumigation chamber are interlocked in a manner that prevents opening of the outer door unless the autoclave has been operated through a “sterilization cycle” or the fumigation chamber has been decontaminated. A system is established for the reporting of accidents, incidents, exposures, and employee absenteeism, and for the medical surveillance of potential laboratory-associated illnesses. An essential adjunct to such a reporting/surveillance system is the availability of a facility for the quarantine, isolation, and medical care of persons with potential or known laboratory-associated illnesses. Infected animals should be housed in a partial containm ent system (such as open cages placed in ventilated enclosures, solid wall and bottom cages covered with filter bonnets and opened in laminar flow hoods, or other equivalent prim ary containment systems). The use of disposable material that does not require cleaning, including animal caging, should be considered. Disposable materials must be autoclaved on exit from the facility and then incinerated. Fatal Cercopithecine herpesvirus 1 (B Virus) Infection Following a Mucocutaneous Exposure and Interim Recommendations for Worker Protection. Summary of Recomm ended Biosafety Levels for Activities in W hich Experimentally or Naturally Infected Vertebrate Animals Are Used. Decontamination of clothing before housing animals and cage dumping corridors effects.
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When broken down by gender quetiapine spasms buy generic sumatriptan 25 mg online, five 5 times more males (one in 54) than females (one in 252) are affected muscle relaxant hamstring buy generic sumatriptan 50mg. The increase in diagnoses may be due in part to muscle relaxant football commercial purchase sumatriptan 25 mg with amex better diagnostic tools spasms right arm discount sumatriptan 50mg, but many believe environmental toxins and genetics hold better clues to the increase in prevalence, although this hasn’t been proven. It’s been proven that a fetus is vulnerable to environmental chemicals during development. Examples of chemicals that, in the 6 past, have been shown to harm fetal development include organophosphate insecticides (eg, 7 8 chlorpyrifos), mercury exposure, and heavy metals (eg, lead). If this is the case, exposure to environmental contaminants could play a significant role in poor neural development or brain function processing. Unfortunately, because of the short amount of time research has been conducted on the link between autism and environmental toxins, causality still remains speculative. Such associations can be 9 seen in the high incidence of autism in twins and genetic siblings who have the disorder. Recently, researchers examined inflammatory disease as a possible cause of autism and found that it 14 could possibly contribute to the etiology of the disorder. These include problems with sensory processing, eating behaviors, and feeding disorders. The slightest change in routine can cause a tantrum or result in the refusal to eat. They also may not be able to eat foods that are touching each other on their plate. The way food smells can cause similar reactions, and there are instances in which children may not recognize certain tastes but can distinguish between others. A dietitian can evaluate the foods the child agrees to eat for potential dietary deficiencies. He or she can watch the child and family during meal times to assess habits that may be hindering food intake. High-fructose corn syrup: One of the main concerns with high-fructose corn syrup involves the manufacturing process. Nevertheless, removing it from the diet whenever possible may be a helpful suggestion. Artificial preservatives: Studies have indicated that artificial preservatives may cause 21 22 sensitive individuals to experience headaches, behavioral/mood changes, or hyperactivity. Artificial sweeteners: Aspartame, acesulfame-K, neotame, and saccharin have been known to cause headaches, mood changes, nausea, vomiting, and diarrhea in the general 23 population. Some medications can affect appetite and cause nausea, vomiting, constipation, hard stools, diarrhea, esophageal reflux, weight gain or loss, sedation, drooling, and sometimes dysphagia, all of which can compromise nutritional status. For example, if a child is constipated, he or she may experience a decrease in appetite. If dysphagia is an issue, he or she may decrease food intake for fear of choking while swallowing. If medication causes sedation, the child may not feel the need to eat even though he or she is hungry. Therefore, the best strategy may be to start one supplement at a time for several weeks to determine whether there’s an improvement in symptoms. If the patient takes one supplement for several weeks and experiences no improvements in symptoms, it means the supplement may not be helpful for that particular patient. If improvements are seen, stopping the supplement for a week or so to determine whether symptoms return can be a good strategy to gauge effectiveness. Some will swallow a pill, while others will prefer a liquid, gummy, or chewable form. Obtaining adequate amounts from food alone may be difficult because of the limited number of foods they may eat. Most omega-3 supplements are made from fish oil, so it’s important to ensure they’re free of mercury. Some supplements contain added vitamin E as a preservative to improve shelf life, while others are bound with dietary calcium to preserve the oil at room temperature. If patients complain of stomach upset or fishy burps but don’t experience this when they eat fish, question the freshness of the supplements. Patients may need to keep the supplements in the refrigerator so they stay fresher longer. The body produces vitamin D when the skin is exposed to the sun’s ultraviolet B rays, but during the cooler months of the year, the sun isn’t out long enough for pregnant mothers to get ample exposure. Other studies, however, have shown that high-dose pyridoxine supplements can cause peripheral or sensory 36-37 neuropathies, and larger doses of magnesium can cause gastrointestinal upset and diarrhea. Moreover, dimethylglycine is touted to improve language skills and the ability to make eye contact. More research is needed to show efficacy of some of the current supplements being used. The National Center for Complementary and Alternative Medicine defines probiotics as live microorganisms—usually bacteria, but they also can include microbes such as yeast—that people can ingest to increase the population of desirable bacteria in the gut. They’re used in the treatment of Candida albicans, a fungus frequently reported as the culprit when a yeast infection is present. It can cause itching and burning of the mucous membranes, skin eruptions, and imbalances in the overall health of the gastrointestinal tract. Digestive enzymes are substances that help break down large macromolecules in foods to smaller substances to facilitate their absorption. Examples of digestive enzymes include proteases that break down proteins or lipases that help break down fat. If a dietitian suspects a patient is experiencing inadequate digestion, digestive enzymes may help. In some cases, 17 digestive enzymes may aid in the removal of toxic compounds from the gut. These two peptides, which appear to have a chemical structure similar to opiates, can cross the blood-brain barrier and cause symptoms 42 such as delayed social and language skills, and withdrawn behavior. There are concerns about the use of a gluten-free/casein-free diet because its planning requires a skilled professional who understands the complexities of elimination diets and the restrictions of appropriate foods. And studies have found that diets lacking gluten and casein raise the risk of decreased bone density and 43 stunted growth. This involves eliminating any known foods or chemicals suspected of triggering symptoms. These foods and chemicals are identified by a blood test called the Mediator Release Test, which shows reactions to multiple foods and chemicals. These reactions involve the immune systems of patients who ingest foods and chemicals to which they’re sensitive. Their immune system identifies these foods and chemicals as foreign invaders, causing the immune system to release mediators to fight off the “invaders. These mediators have been shown to cause reactions such as inflammation, diarrhea, pain, intestinal cramping, constipation, headache, and pain receptor changes. Reactions to certain foods and chemicals also can cause the release of the brain neurotransmitters dopamine and serotonin. Dopamine appeals to the sense of reward and enjoyment, and plays a role in addictive behavior. It’s in these instances where the Mediator Release Test may help with identifying reactive substances that can be eliminated to improve behavior, communication skills, and other immune-related health issues and allow for more variety in the diet for better nutrition. More and more patients will depend on dietitians as the source of information that will enable patients to live productive lives. Dietitians with the passion to work with this challenging segment of the population will be a much-needed resource in the dietetics community in the years to come. Mercury exposure, nutritional deficiencies, and metabolic disruptions may affect learning in children. Maternal infection requiring hospitalization during pregnancy and autism spectrum disorders. An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases. Food dyes impair performance of hyperactive children on a laboratory learning test. The monosodium glutamate symptom complex: assessment in a double-blind, placebo-controlled, randomized study. Role of polyunsaturated fatty acids in the management of Egyptian children with autism.
Management is by strict control of blood glucose levels spasms the movie purchase sumatriptan from india, treatment of neuropathic pain and the prevention of foot and leg ulcers much in the same way as in leprosy spasms spasticity muscle sumatriptan 50 mg amex. Dry beriberi results in a sensory motor polyneuropathy while wet beriberi results in cardiac failure and generalised oedema muscle relaxant addiction buy genuine sumatriptan on-line. Beriberi in Africa is mainly caused by malnutrition arising from food shortages and also occasionally from alcoholism muscle relaxant pregnancy buy discount sumatriptan line. Treatment for both conditions is by thiamine replacement either intravenously or orally. Vitamin B-6 defciency Pyridoxine (Vit B-6) defciency causes a mainly sensory neuropathy. It can be prevented by giving pyridoxine 20-50 mg orally daily, whenever isoniazid is used. Overdoses of vitamin B-6 may actually cause neuropathy so it is important to avoid doses greater than 100 mg daily. Vitamin B-12 defciency may be less common in Africa than in high income countries. The main clinical fndings of the neuropathy are absent ankle jerks, loss of peripheral sensation (especially joint position and vibration) in combination with brisk knee refexes and up going plantar responses. Malabsorption may be due to lack of intrinsic factor and diseases of the terminal ileum. Treatment is with hydroxycobalamin (Vit B-12) 1 mg (1000 micrograms) intramuscular injections on alternate days for a total of fve injections or 5 mg. In the absence of severe malabsorption, replacement can be given orally at a dose of 1 mg daily. Apart from malnutrition related thiamine defciency, alcohol causes a direct efect on nerves by the toxic efect of its metabolites. It presents with a history of a slowly progressing burning dysasthesia mainly in the feet and legs over months or years in a person misusing alcohol. On examination, there are signs of a distal sensory motor neuropathy usually without signifcant loss of power. Treatment is to stop the alcohol and replace thiamine (Vit B-1) although painful symptoms frequently persist. It presents as an acute progressive usually ascending faccid paralysis that reaches its peak usually around 10-14 days but always by defnition in less than 4 weeks. This is followed by a plateau phase and eventual recovery for most patients after 3-6 months. Two thirds of cases are associated with a history of preceding febrile illness, diarrhoea, immunization or surgery during the previous 2-3 weeks. Clinical features The presenting complaint is that of a rapidly developing motor weakness occurring over days and sometimes hours. Sensory symptoms, mainly paraesthesiae, often painful may accompany the weakness but these are usually mild. Lower motor neurone type facial weakness occurs in about half the patients but may be mild and is frequently bilateral. Tese include transverse myelitis, organophosphorous poisoning, diphtheria, polio, botulinum and lead poisoning. If available, nerve conduction studies will show marked slowing of motor conduction velocities characteristic of a demyelinating polyneuropathy. Nursing care is directed at checking for signs of increasing weakness, respiratory failure and the prevention of bedsores and contractures. The vital signs and in particular the vital capacity should be measured 4 hourly for the frst few days of the illness. The heart should be monitored for arrhythmias and any surges in blood pressure treated with beta blockers. Compression stockings and low dose heparin are used to prevent deep vein thrombosis and pulmonary emboli. Disease progression, respiratory failure and signifcant disability are all indications for their use and they should be administered within the frst 2 weeks of onset of the illness, as they are not of value after that time. Teir main role is to halve the average period of hospital stay from about 12 to 6 weeks. However, these treatments are mostly unavailable because of their high cost and limited resources. Recovery in the remaining 90% is good but some (10-20%) remain partially disabled at 12 months. The clinical features are characterized by a mixed motor sensory peripheral neuropathy usually with proximal as well as distal weakness. Treatment is with high dose steroids prednisolone initially 60 mg/od for 4-6 weeks, reducing slowly over months until on a minimum maintenance dose of 5-20 mg on alternate days. Response to immunosuppression is good but may have to be continued in the longer term. Neuropathy in Ethiopian diabetics: a correlation of clinical and nerve conduction studies. Guillain-Barre syndrome in northern Tanzania: a comparison of epidemiological and clinical fndings with western Norway. Increased incidence of symptomatic peripheral neuropathy among adults receiving stavudine versus zidovudine based antiretroviral regimens in Kenya. A clinical, epidemiological and genetic study of hereditary motor neuropathies in Benghazi, Libya. The author and the publisher waive any and all liability for damages, injury or death to persons or property incurred, directly or indirectly by this publication. The clinical skills needed to examine the individual cranial nerves are presented in chapter 1. The overall aim of this chapter is to present the main cranial nerve disorders and to integrate examination and localization in their diagnosis. After reading the chapter the student should be able to localize and diagnose main disorders afecting pupils, vision, eye movements, facial sensation and movements, hearing, speech and swallowing. During a routine neurological examination it is sufcient to ask the patient if there is a loss or decrease in the sense of smell (anosmia). Frequently patients are unaware of a loss of smell or may only complain of losing their sense of taste. This is because both smell and taste are used together to appreciate the favors of food and drink. If there is a loss or deterioration in smell, then each nostril should be tested separately as outlined in chapter 1. The most common cause of transient loss of smell is mucosal swelling in the nose or sinuses as a result of local infection. Anosmia may occur after a head injury when there is a shearing injury to the olfactory bulb and its central connections through the cribriform plate. Optic nerve Disorders afecting the optic nerve are common and clinical assessment involves a history and examination. The history involves asking about a loss or decrease in vision, double vision, pain and headache and their mode of onset, progression and time course. The examination of the optic nerve includes testing the pupillary responses, visual acuity, visual felds and fundoscopy. Details concerning the technique of examination have already been set out in chapter 1. It does this by means of two groups of muscle fbres supplied by William Howlett Neurology in Africa 287 Chapter 12 Cranial nerve disorders the autonomic nervous system. The sphincter pupillae is a circular constrictor smooth muscle supplied by the parasympathetic and the dilator pupillae is a radial smooth muscle supplied by the sympathetic nervous system. The light in one eye sends an aferent impulse along the optic nerve to the midbrain. The aferent anatomical pathway to the midbrain involves the retina, optic nerve, chiasm and optic tract. From the midbrain, a second order neurone travels to the Edinger Westphal nucleus on both the same and opposite side of the midbrain. From there, eferent parasympathetic fbres travel back to the eyes, via the outside of the oculomotor nerve to the ciliary ganglion and to the constrictor sphincter pupillae. If all pathways are working normally, then the pupils in both eyes constrict equally and at the same time in response to light shone in one eye (Fig 12. This represents the normal light refex in the light stimulated eye and the consensual refex (response) in the other eye.