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Children with impaired growth are said to heart attack vol 1 pt 3 buy cheap perindopril on line be "stunted" and the phenomenon is called "stunting" hypertension question and answers cost of perindopril. The percentage of wasted children in low income countries is 8% hypertension 24 hour urine test buy perindopril 4mg amex, ranging from 15% in Bangladesh and India down to blood pressure medication migraines generic 8 mg perindopril otc 2% in Latin America (3). Different kinds of disasters may raise the figures dramatically in affected areas. This presents a disturbing picture of malnutrition among children under five years of age in underprivileged populations. These children should be an important target group for any kind of nutritional intervention to be undertaken in these countries. The global average for stunting among children in low income countries is 32% (3). Increasing evidence shows that stunting is associated with poor developmental achievement in young children and poor school achievement or intelligence levels in older children. Efforts to accelerate economic development in any significant long-term sense will be unsuccessful until optimal child growth and development are ensured for the majority" (3). It is also methodologically difficult to differentiate the effect of general malnutrition from the effect of micronutrient deficiencies, such as iodine deficiency during pregnancy and iron deficiency in childhood, which also cause mental and physical impairments. Malnourished children lack energy, so they become less curious and playful and communicate less with the people around them, which impairs their physical, mental and cognitive development. Two recent reviews highlight the evidence of general malnutrition per se causing long-term neurological deficits (4, 5). An increasing number of studies consistently show that stunting at a young age leads to a long-term deficit in cognitive development and school achievement up to adolescence. Episodes in young childhood of acute malnutrition (wasting) also seem to lead to similar impairments. The studies also indicate that the period in utero and up to two years of age represents a particularly vulnerable time for general malnutrition (4). In addition to food supplementation, it has been nicely demonstrated that stimulation of the child has long-term beneficial effects on later performance. One such study is from Jamaica, where stunted children who were both supplemented and stimulated had an almost complete catch-up with non-stunted children (6), see Figure 3. Treatment of severe malnutrition If a child becomes seriously wasted, this in itself is a life-threatening condition. Even if the child is brought to hospital, the risk of dying still remains very high. An important element, in 114 Neurological disorders: public health challenges addition to initial treatment similar to intensive care, is to stimulate the child in order to prevent the negative long-term effect on the cognitive capacity of the child. Micronutrient deficiencies Micronutrients is the term used for those essential nutrients that are needed in small amounts for human growth and functioning. They are essentially used as cofactors for enzymes engaged in various biochemical reactions. They comprise vitamins, fat-soluble as well as water-soluble, and trace elements (= minerals). Iron, vitamin A, zinc and iodine are most discussed today, but other important micronutrients are vitamin C and the vitamin B complex. Diets that supply adequate energy and have an acceptable nutrient density will usually also cover the needs for micronutrients. When the diet is otherwise monotonous, however, it is recommended to supplement it with micronutrient-rich foods. Food preservation methods, high temperature and exposure to sunlight can reduce the activity of many vitamins. Some of these conditions are much more significant with regard to their global occurrence and their impact on the nervous system than other micronutrient deficiencies, so this section focuses on deficiencies of vitamin A, vitamin B complex, iodine and iron. Vitamin A deficiency Vitamin A assumes two types of function in the body: systemic functions (in the whole body) and local functions in the eye. Vitamin A is very important for the mucous membranes as it is needed for the proper production of mucopolysaccharides, which help to protect against infections. If vitamin A is deficient, the wetness of the mucous membranes will decrease and the membranes will become more like skin than mucous membranes. Inside the eye, vitamin A is used in the rods (the receptors for low intensities of light). If there is too little vitamin A, the person will not be able to see in low light intensity: he or she will become nightblind. Vitamin A deficiency has long been identified as the major cause of nutritional blindness. It is the single most important cause of blindness in low and middle income countries. Vitamin A deficiency develops quite quickly in children with measles, as infections make the body consume its vitamin A stores much more quickly. Children between six months and four years old are most vulnerable to vitamin A deficiency. An estimated 100 million pre-school children globally are estimated to have vitamin A deficiency and 300 000 are estimated to die each year because of vitamin A deficiency. In order to prevent child deaths and childhood blindness, many low income countries have integrated vitamin A supplementation into their immunization programmes. Vitamin B deficiencies have occurred in extreme situations in the past, such as in the 19th century when the steam mills in South-East Asia started to provide polished rice. Suddenly, people had enough energy but insufficient supply of B vitamins and developed beri-beri, a Sinhalese word for "I cannot". It may also occur today in refugee populations, if they are provided with a very limited choice of food items with enough energy but deficient in B vitamins. Similarly, it may also happen to alcoholics and people with other types of very monotonous diets. The different deficiency syndromes of vitamin B overlap and are sometimes very difficult to distinguish from one another. A recent example is the Cuban neuropathy in the mid-1990s, in which over 50 000 people suffered from a gait and visual disturbance, technically a polyneuropathy (8, 9). It is now known that the population that experienced the epidemic had an extreme diet (tea with sugar as the main source of energy; which is likely to generate a vitamin B deficiency) and the epidemic stopped as soon as universal distribution was made of tablets with vitamin B complex. This led the scientists to conclude that it was a vitamin B complex deficiency, without being able to distinguish the vitamins from each other. From a public health perspective, therefore, the B vitamins may as well be treated together, the only exceptions being vitamin B12 and folate. Beri-beri is one form of vitamin B1 deficiency, and the main symptom is a polyneuropathy in the legs (10). In severe cases, one can suffer from cardiovascular complications, tremor, and gait and visual disturbances. It is characterized by a serious confusion, unsteadiness and eye movement disorders. It can be rapidly reversed if correctly diagnosed and immediately treated with high-dose thiamine. Deficiency of niacin leads to "pellagra", an Italian word for "rough skin", which was common in Italy and Spain in the 19th century when large populations were sustained on a maize diet. In its classic form it appears with three Ds: dermatitis, diarrhoea and dementia; that is with cutaneous signs, erythema, pigmentation disorders, diarrhoea and neuropsychiatric disturbances such as confusion and psychomotor agitation. Neuropsychiatric disorders including seizures, migraine, chronic pain and depression have been linked to vitamin B6 deficiency (11). Some studies have suggested that neurological development in newborns could be improved by supplementation in pregnancy, but this is still a hypothesis (12). Vitamin B6 deficiency may occur especially during intake of some drugs which antagonize with the vitamin. Folate (or folic acid) plays an important role for rapidly dividing cells such as the blood cells, and a folate deficiency causes a special type of anaemia called megaloblastic anaemia which is reversible when folate is given. Folate supplementation for women at the time of conception protects against neural tube defects (13).

Identified how professional obligations imposed by the Warrior Ethos shaped character development hypertension used in a sentence purchase cheapest perindopril. You observe a behavior or pattern of behavior in a subordinate that requires leader intervention heart attack belanger remix discount 2mg perindopril overnight delivery, or are given a requirement to blood pressure chart senior citizens discount perindopril online mastercard conduct counseling blood pressure medication yellow teeth trusted 4mg perindopril. Standards: Correctly identify the need for counseling and/or type of counseling required. Prepare for the counseling session by: 1) selecting a suitable place, 2) scheduling a time, 3) notifying the subordinate in advance, 4) organizing information, 5) outlining the counseling session component,; 6) planning a counseling trategy, and 6) establishing the right atmosphere. Conduct the counseling session to include: 1) opening the session, 2) discussing the issues, 3) developing a plan of action, 4) documenting the counseling session, and 5) closing the session. Conduct a follow-up of the counseling session to assess the plan of action and adjust it if necessary. This task is best evaluated using a role playing scenario and an assistant to act as the subordinate. Prepare a scenario that requires the Soldier to perform accurately, according to task standards, to the following performance measures. Provided training opportunities to improve subordinates self-awareness, confidence, and competence. Perform all leader actions throughout the formation, enrichment, and sustainment stages of team building and develop an assessment plan to measure team effectiveness. Upon assignment to a leadership position, implement a plan to apply effective team building techniques. General team building actions: (1) Implement an effective reception and orientation plan. Evaluation Preparation: Setup: Provide the Soldier with the references listed below. The Soldier should be evaluated against the performance measures listed dependent on whether the team building event is for general team building purposes or in preparation for a deployment. General team building actions: - - - - (1) Implemented an effective reception and orientation plan. Standards: Apply each step of the military problem solving process to solve a problem. Prepare a scenario that requires the student to respond accurately, according to task standards, to the following performance measures. You may have a litter and straps (or materials to improvise them) to secure the casualty and other Soldiers available to assist in treatment and evacuation. Standards: Ensure that self-aid/buddy aid is provided to the casualties, as appropriate. Ensure that the casualties are transported to medical aid or to a pickup site using an appropriate carry or, if other Soldiers are available, by litter. Ensure that the litters are properly loaded onto a military vehicle (ground vehicle or rotarywing aircraft) without dropping or causing further injury to the casualties. Performance Steps Note: Perform these procedures when medical and combat lifesaver personnel are not available. As soon as medical personnel are available, assist them, as necessary, in treating and evacuating the casualties. Coordinate treatment (self-aid/buddy aid) of the casualties according to the tactical situation and available resources. Determine whether casualties must be moved or will be picked up at the current location. Note: If military vehicles and litter materials are not available, continue with step 5. Note: Four-man litter squad bearers should be designated with a number from 1 to 4. The front and back bearers release the litter and the middle bearers rotate the litter and themselves. Note: Ground ambulances have medical personnel to take care of the casualties during evacuation. Note: Air ambulances have medical personnel to take care of the casualties during evacuation. Ensure that the aircrew can continue to visually distinguish friendly from enemy personnel at all times. If you must move to the opposite side of the aircraft, approach from the side to the skin of the aircraft. Then, hug the skin of the aircraft, and move around the front of the aircraft to the other side. Note: this is done to keep the casualty from accidentally falling on another casualty if his/her litter is dropped before it is secured. Note: Nonmedical military vehicles may be used to evacuate casualties when no medical evacuation vehicles are available. If medical personnel are present, follow their instructions for loading, securing, or unloading casualties. Coordinated treatment (self aid/buddy aid) of the casualties according to the tactical situation and available resources. Standards: Recognize stress-related behaviors and implement appropriate leader actions that offset and control combat and operational stress reaction risk factors. Positive combat stress behaviors include the heightened alertness, strength, endurance, and tolerance to discomfort which the fight or flight stress response and the stage of resistance can produce when properly in tune. More serious behaviors are warning signs and deserve immediate attention by the leader, medic, or buddy to prevent potential harm to the Soldier, others, or the mission. Some people have stress reactions that do not go away on their own, or may even get worse over time. An effective leader will ensure that a Soldier understands that there are many normal physical and emotional reactions. It is imperative that the small group leader also verbally and nonverbally illustrate that the expectation is for the Soldier to improve and rejoin his/her organization as a fully functioning member. If the combat and operational stress reaction signs continue- (1) Get the Soldier to a safer place. If the unit cannot wait for the Soldier to recover, he/she must be moved to the first level medical supporting unit. From there, every effort is made to move the Soldier to a nonmedical unit or area (a tent or building of opportunity could suffice) for rest, replenishment, and reassurance. If the tactical situation permits, give the Soldier simple tasks to do when not sleeping, eating, or resting. Brief Soldier: Tell the Soldier that he/she will be required to correctly respond to questions about combat stress behaviors. Wake the Soldiers and have them reseal their masks if the seal appears to be broken. Wake the Soldiers and have them decontaminate using the M291 if their skin is exposed or they appear to be contaminated with liquid. Perform first aid for nerve-agent injuries if skin is exposed or nerveagent symptoms are observed. Evaluation Preparation: Setup: Evaluate this task during a normal training session. Place sandbags on the floor and sides of all vehicles (within reason for nonarmored vehicles). Ensure that they wear handkerchiefs or similar cloths over their noses and mouths to keep from breathing radioactive dirt or dust. Skill Level 3 031-503-3004 3-121 Performance Steps (5) Ensure that vehicles are far enough apart during movement to minimize dust. After crossing- (1) Have personnel check themselves and their equipment for contamination. During crossing- (1) Ensure that vehicles are far enough apart during movement to minimize dust. Continuously monitor personnel for chemical-agent symptoms, and give first aid as required. After crossing- (1) Continue to monitor Soldiers for chemical-agent symptoms, and give first aid as required.

Noonan like syndrome

Shortly after the beginning of the riparian restoration project arrhythmia associates of south texas purchase 2mg perindopril otc, several local ranchers reported atypical late-term abortions blood pressure jumps from low to high discount perindopril 8 mg without prescription. There have been reports by several ranchers of 10 to arteria y vena femoral buy generic perindopril 8 mg on-line 15 percent of their herds aborting after being pastured in these areas (personal communications) arterial blood generic 4 mg perindopril. However, there was clear visual evidence that the cattle had been eating the bark of the downed western juniper trees. Therefore, samples of western juniper needles, berries, and bark were analyzed for labdane acid content. Both the needles and berries were found to contain low concentrations of labdane acids. However, preliminary analyses indicated that the bark of western juniper trees had a fairly high concentration of labdane acids (~ 1. Consequently, the objective of this study was to determine if the bark from western juniper trees could induce abortions in cattle. The bark was allowed to dry at ambient temperature and then stored on a canvas tarp in an enclosed, non-heated, un-insulated building at ambient temperature until treatment. This dose has been previously shown to be well tolerated and will consistently induce abortion with ponderosa pine needles containing 1. Dosing continued daily until abortion or day 260 of gestation (maximum of 20 doses/animal). In this study, if the placental membranes were not expelled within 24 hours after parturition, the animals were treated with uterine lavage and intrauterine antibiotic infusions. Blood samples were collected via the jugular vein prior to treatment each morning. Blood samples were allowed to clot at room temperature for 30 min and then centrifuged at 1700 x g for 20 min to separate the serum from the cellular fractions. Analytical methods-The concentration of labdane acids in the plant material was measured by gas chromatography. Gas chromatography was performed as previously described (Gardner and James 1999). Samples were then analyzed for metabolites of isocupressic acid (agathic acid, dihydroagathic acid, and tetrahydroagathic acid) by gas chromatography/ mass spectrometry. Peak areas of the detected metabolites were measured from selected ion chromatograms, referenced against the C17 standard and then plotted versus day collected to measure relative concentration of metabolites in the sera samples. This concentration of labdane acids was greater than the threshold concentration (0. The concentration of those two labdane acids in this plant material was approximately 0. Gas chromatography/mass spectrometry chromatograms and the major diterpene acids identified from the plant material. The amount of plant material dosed daily, the corresponding daily dose of labdane acids, and the number of days to parturition after start of treatment Daily Labdane Daily Agathic Daily Weight Daily Plant Days to Animal Acid Dose Acid Dose Imbricatoloic Acid (kg) Dose (g/kg) Parturition (mg/kg) (mg/kg) Dose (mg/kg) 1 623 7. Both abortions were typical of pine needle-induced abortions, including parturition 4 to 5 days after treatment started as well as typical clinical signs including dystocia and retained placental membranes (James et al. The remaining 4 cows calved normally 26 to 31 days after the start of treatments on gestation days 276 to 281. There were no complications observed during parturition and no retained placental membranes in these four cows. In this study, there was not a dose-response relationship observed between the amount of labdane acids dosed and the number of days to parturition (table 1). One of the cows that aborted received the highest daily dose of labdane acids (56. However, the other cow that aborted received one of the lowest daily doses of labdane acids (47. The cows that did not abort received a daily dose of labdane acids that was in between the range to those that did abort (47. Additionally, there was no correlation between the dose of labdane acids received and the number of days to parturition (P=0. Sera samples were analyzed to determine if the variation in results observed in this study was due to the amount of bioavailable labdane acids in the cattle. However, the animals that aborted did not have a higher concentration of any of the labdane acids in their sera; in fact, there was a trend for the two cows that aborted to have a lower sera concentration of agathic acid (figure 3A). Discussion It has been known for many years that pine needleinduced abortion is a problem, estimated at $4. The results from the study presented here demonstrate that the bark from western juniper trees can also induce abortions in cattle. The State of Oregon is currently clearing large areas of western juniper trees in an attempt to recover critical grasses in mountain ranges used by wildlife and livestock for grazing. As a result of these efforts, large piles of downed western juniper trees are available to cattle in many Oregon rangelands. The results observed in this study were varied, in that only two of the six cattle aborted. Additionally, the variation cannot be explained by differences in the daily dose of labdane acids administered to the cattle. Consequently, the concentration of known abortifacient labdane acids in this plant material was 0. Comparison of labdane acid concentrations in sera of cows that aborted versus cows that calved at full term. Therefore, it is possible that the variation in response was due to the lack of abortifacient compounds in the bark and consequently only the two most susceptible animals aborted. These results are in accordance with most field observations wherein 10 to 20 percent of a herd will abort when they are exposed to pine needles during a large winter storm (personal communications), suggesting that normally only the most susceptible animals have a problem. Typically, when a compound is administered multiple times, it will lead to accumulation of the compound in the body (Shargel and Yu 1993, Shen 2008). For example, if a compound follows firstorder elimination kinetics, the elimination rate increases as the body burden increases. Thus, with a fixed, continuous exposure, accumulation of a compound in the body reaches a point when the rate of intake equals the rate of elimination for that compound. From that point forward, the body burden remains constant, which is commonly referred to as a steady state (Shen 2008). One possible explanation for this observation is that multiple doses of these compounds could result in an induction of the enzymes/pathways that are involved in the elimination of these compounds from the body (Meyer and Gut 2002, Parkinson and Ogilvie 2008). Additionally, multiple dosing of these compounds orally may induce a change in the rumen microflora 77 Welch et al. In conclusion, the bark from western juniper trees contains labdane acids that have been associated with abortion in cattle. Consequently, livestock producers should be aware of the potential for western juniper trees to induce abortions in lateterm pregnant cattle, especially if grazing conditions deteriorate so that cattle are compelled to eat juniper. Acknowledgments the authors thank Kendra Dewey, Kermit Price, Clint Stonecipher, Scott Larsen, Al Maciulis, Rex Probst, and Danny Hansen for their technical support. Pine needle abortion in cattle: analysis of isocupressic acid in North American gymnosperms. Ponderosa pine needle-induced abortion in beef cattle: identification of isocupressic acid as the principal active compound. Implication of agathic acid from Utah juniper bark as an abortifacient compound in cattle. Management practices to minimize death losses of sheep grazing halogeton-infested range. Effect of feeding ponderosa pine needle extracts and their residues to pregnant cattle.

Rasmussen subacute encephalitis

Sudden onset of these symptoms progressing over minutes should be considered a neurological emergency unless proven otherwise blood pressure chart what your reading means purchase perindopril amex. The most common is onset of sudden severe headache and initially retained consciousness blood pressure monitor app cheap 8mg perindopril overnight delivery. Because bleeding is predominantly around the brain arrhythmia consultants of connecticut perindopril 8 mg low price, there are usually no early focal neurological findings (but see below) blood pressure chart stage 2 discount 4mg perindopril with mastercard. Rule of thumb: Top areas for saccular aneurysms at branch points within basal brain arteries A. The common clinical picture is an abrupt onset severe headache followed by reduced arousal level, and sometimes coma. Lateralizing features, such as headache that primarily involves one hemisphere, monocular pain, or unilateral retinal hemorrhage may occur. Unilateral blindness with retained consciousness is suggestive of an ophthalmic artery or the branching of the internal carotid artery. Mortality and increased likelihood of poor outcome occurs with ventricular and/or intraparenchymal extension. Patients with extensions of the hemorrhage have increased likelihood of coma and development of hydrocephalus. Damage to the brain parenchyma can occur by a variety of causes, including blood products, ischemia due to decreased arterial blood volume and/or subsequent vasospasm, increased intracranial pressure and effects from craniotomy and/or infection. Deficits frequently involve attention/concentration, executive skills, memory, and language functions as well as personality and mood changes related to bilateral frontal lobe dysfunction. Attention deficits typically include reduced sustained attention and increased distractibility. Executive impairments are common, and patients can present with a variety of cognitive and personality changes associated with mesial and/or orbitofrontal lobe syndromes including decreased initiation, behavioral apathy, reduced verbal output (mutism), or, alternatively, behavioral disinhibition, agitation, increased energy level, reduced personal hygiene, and difficulty learning from trial and error (see Chap. Memory can be markedly impaired, particularly if basal forebrain areas are damaged. Memory impairment is of declarative (explicit) memory, and the patient can be densely amnestic. Confabulation is frequently found, and mood symptoms can include paranoia, delusions, and obsessivecompulsive behaviors. Improvement in neuropsychological function after AcoA aneurysm rupture does occur, but most patients will exhibit residual impairments. Importantly, the description below assumes normal neuroanatomical functional organization, with the patient being left hemisphere dominant for language. Right hemianesthesia, including pain, temperature, light touch, position, and vibration sense (primary sensory cortex). Ideomotor apraxia, ideational apraxia, constructional apraxia (left frontal and parietal cortex). Acute ipsilateral monocular blindness (damage to optic nerve) and right homonymous hemianopsia, which tends to resolve (optic radiations). Frontal lobe behavioral problems (dorsolateral frontal lobe syndrome) including grasp, root, suck reflexes, impaired sequencing, poor problem solving. Frontal lobe behavioral problems (medial frontal syndrome) including akinesia, mutism, abulia (lack of initiative or drive). Right homonymous hemianopsia is possible, left gaze preference (lesion of left frontal eye field that would drive eyes to right leading to left gaze). Mood changes are common (see Image D), frequently with depressive symptoms that can be quite prominent. Some face and arm sensory loss may be present, depending on how posterior the vascular extended into the parietal lobe. Memory deficits are possible (verbal may be more impaired than "visual" memory, see Chap. Anosagnosia, left neglect, ideational apraxia, constructional apraxia (right frontal and parietal cortex). Left hemianesthesia, including pain, temperature, light touch, position, and vibration sense (primary sensory cortex). Acute ipsilateral monocular blindness (prechiasmic damage to optic nerve) and left homonymous hemianopsia, but tends to resolve (optic radiations). Left homonymous hemianopsia possible, with right gaze preference (lesion of right frontal eye field which drives eyes to left). Mood changes are common, with initial symptoms of hypomania and jocularity, but affective flattening may occur. Initially, the left hemineglect can be pronounced, and limit the ability to evaluate for left visual field defects or any left motor weakness. Some face and arm sensory loss may be present, depending on how posterior the ischemic penumbrae extended into the parietal lobe. Frontal lobe behaviors may be present, particularly dorsolateral syndrome behaviors of poor problem solving, impaired sequencing, perseveration, poor reasoning. Motor and sensory loss of the hand and face is possible if lesion is large and damages thalamus and internal capsule. The Lacunar Syndromes Lacunes are small subcortical infarcts (generally considered to be < 1. Classically, Fisher (1982) described five lacunar syndromes: pure motor hemiparesis, pure sensory stroke, sensorimotor stroke, ataxic hemiparesis, and clumsy-hand dysarthria. We discuss the lacunar syndromes of the thalamus in a subsection below, as these present with greater neuropsychological deficits. Anterior choroidal artery Posterior limb of internal capsule, Pons (anterior portion) Cerebral peduncle Corona radiata (continued) 327 328 Table 13. Clinical features Localization Medial pons damaging corticospinal and corticobulbar tracts. Cerebral peduncle genu of internal capsule Pure motor hemiparesis with Contralateral: hemiparesis of face and arm dysarthria. Schoenberg Pure motor hemiparesis with ataxia (Ataxic Hemiparesis) No sensory loss. Assuming functional use of writing hand, the patient is able to write (and read) without difficultly. Important to distinguish clumsy hand movements due to hemiparesis (lesion of upper motor neurons) from apraxia Ipsilateral: None Penetrating branches of Basilar artery (paramedian artery). Perhaps the best known are the pure sensory and the pure sensorimotor strokes, identified in Table 13. Thalamic pain, a central pain disorder, can result from occlusion of the inferolateral (thalamogeniculate) artery and is contralateral to the lesion. Thalamic pain, if present, is usually associated with hemisensory loss, mild hemiparesis, choreoathetotic movements, and sometimes a mild hemiataxia and astereognosis. Alternatively, outcome from occlusion of the tuberothalamic or paramedian arteries tends to be poor, often with persistent neuropsychological deficits. Bilateral lesion anterograde amnesia Unilateral less memory impairment Confabulation may be present. Behavioral apathy with somnolescence (reduced level of alertness) Unilateral lesion less persistent apathy. Akinetic mutism can be present with bilateral lesion or dominant hemisphere lesion 3. Confabulation may be present Contralateral homonymous quadrantanopia Larger lesion results in hemianopsia. Cerebrovascular Disease and Stroke Paramedian arteries Posterior choroidal artery Lateral geniculate nuclei (continued) 331 332 Table 13. Impaired declarative (explicit) memory (autobiographical memory poor from time of lesion, and reduced ability to remember new facts). Dominant hemisphere lesions more impairment in verbal memory Nondominant hemisphere lesions more impaired "nonverbal" (visuospatial) memory.

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