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WILLEIT J, KIECHL S, KIECHL-KOHLENDARFER U, et al: Juvenile asymmetric segmental spinal muscular atrophy (Hirayama s disease): Three cases without evidence of exion myelopathy Acta Neurol Scand 104: 320, 2001 WILLIAMS B: The cystic spinal cord J Neurol Neurosurg Psychiatry 58: 649, 1995 WILLIAMS CS, BUTLER E, ROMAN GC: Treatment of myelopathy in Sjo gren syndrome with a combination of prednisone and cylcophosphamide Arch Neurol 59:875, 2001 WINKELMAN MD: Neurological complications of thermal and electrical burns, in Aminoff MJ (ed): Neurology and General Medicine New York, Churchill Livingstone, 1994, pp 915 929 WINKELMAN MD, ADELSTEIN DJ, KARLINS NL: Intramedullary spinal cord metastases: Diagnostic and therapeutic considerations Arch Neurol 44:526, 1987 WOLTMAN HW, ADSON AW: Abscess of the spinal cord Brain 49:193, 1926 WOOLSEY RM, YOUNG RR(eds): Neurologic Clinics: Disorders of the Spinal Cord Philadelphia, Saunders, 1991 WYBURN-MASON R: Vascular Abnormalities and Tumors of the Spinal Cord and Its Membranes St Louis, Mosby, 1944 YOGANANDEN N, LARSON SJ, GALLAGHER M: Correlation of microtrauma in the spine with intraosseous pressure Spine 19:435, 1994 ZWIMPFER TJ, BERNSTEIN M: Spinal cord compression J Neurosurg 72: 894, 1990

A, Pentium Pro, B, Pentium with MMX, and C, Pentium II, are incorrect because they were all developed before the creation of the technology used in the E and B variants and SIMD instructions

The clinical suspicion of neuromuscular disease, disclosed by any of the symptoms or syndromes in the succeeding chapters, nds ready con rmation in the laboratory The intelligent selection of ancillary examinations requires some knowledge of the biochemistry and physiology of muscle ber contraction, nerve action potentials, and neuromuscular conduction These basic subjects, with the relevant anatomy, serve as an introduction to the descriptions of the laboratory methods and the subject matter of the chapters that follow

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It is not possible here to review all the biochemical and biophysical data that explain nerve impulse generation and conduction Since the early studies of Hodgkin (1951) and of Hodgkin and Huxley (1952), tomes have been written on these subjects Suf ce it to say that the nerve and muscle bers, like other bodily cells, maintain a uid internal environment that is distinctly different from the external or interstitial medium The main intracellular constituents are potassium (K), magnesium (Mg), and phosphorus (P), whereas those outside the cell are sodium (Na), calcium (Ca), and chloride (Cl) In both nerve and muscle the intracellular concentrations of these ions are held within a narrow range by electrical and chemical forces, which maintain the membranes in electrochemical equilibrium ( resting membrane potential ) These forces are the result of selective permeability of the membranes to various ions and the continuous expulsion of intracellular Na through special channels by a pump mechanism ( the sodium pump ) The function of the pump is dependent on the enzyme Na-K-ATPase, which is localized in the membranes This resting membrane potential is therefore dependent on the differential concentrations of K and Na The interior of the cell is some 30 times richer in K than the extracellular uid, and the concentration of Na is 10 to 12 times greater in the extracellular uid In the resting state, the chemical forces that promote diffusion of K ions out of the cell (down their concentration gradient) are counterbalanced by electrical forces (the internal negativity opposes further diffusion of K to the exterior of the cell) At the resting potential, the situation of Na ions is the opposite; they tend to diffuse into the cell, both because of their concentration gradient and because of the relative negativity inside the cell Because the resting membrane is less permeable to Na than to K, the amount of K leaving the cell exceeds the amount of Na entering the cell, thus creating the difference in electrical charge across the membrane This discrepancy, in association with the actions of the electrogenic Na:K pump and the presence of impermeant, negatively charged intracellular proteins, creates an electrical potential across the membrane such that, in the resting 1092.

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