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Cross References Caloric testing; Coma; Dolls eye manoeuvre, Dolls head manoeuvre; Hallpike manoeuvre, Hallpike test; Head impulse test; Ocular tilt reaction; Oculocephalic response; Oscillopsia; Supranuclear gaze palsy; Vertigo Vibration Vibratory sensibility (pallaesthesia) represents a temporal modulation of tactile sense. On this ground, some would argue that the elevation of vibration to a sen- sory modality is not justied. This assesses the integrity of rapidly adapting mechanoreceptors (Pacinian corpuscles) and their peripheral and central connections; the former consist of large afferent bres, the latter consist of ascending projections in both the dorsal and lateral columns. The classication of both vibration and proprio- ception as posterior column signs, sharing spinal cord and brainstem pathways, is common in neurological parlance (and textbooks) but questioned by some. Instances of dissociation of vibratory sensibility and proprioception are well rec- ognized, for instance the former is usually more impaired with intramedullary myelopathies. Decrease in sensitivity of vibratory perception (increased perceptual thresh- old) is the most prominent age-related nding on sensory examination, thought to reect distal degeneration of sensory axons. Cross References Age-related signs; Myelopathy; Proprioception; Two-point discrimination Visual Agnosia Visual agnosia is a disorder of visual object recognition. Reading is performed with great difculty, with a slavish tracing of letters which is easily derailed by any irrelevant lines; such patients may appear blind. The scope of this impairment may vary, some patients being lim- ited to a failure to recognize faces (prosopagnosia) or visually presented words (pure alexia, pure word blindness. Critchley) have taken the view that there is always some qualitative or quantitative disorder of sight, and hence that to isolate subtypes is a vain pursuit. Visually agnosic patients can recognize objects presented to other sensory modalities. Clinically, apperceptive visual agnosia lies between cortical blindness and associative visual agnosia. Apperceptive visual agnosia results from diffuse posterior brain damage; associative visual agnosia has been reported with lesions in a variety of locations, usually ventral temporal and occipital regions, usually bilateral but occasionally unilateral. Pathological causes include cerebrovascular disease, tumour, degen- erative dementia (visual agnosia may on occasion be the presenting feature of Alzheimers disease, the so-called visual variant, or posterior cortical atrophy), and carbon monoxide poisoning. A related syndrome which has on occasion been labelled as apperceptive visual agnosia is simultanagnosia, particularly the dorsal variant in which there is inability to recognize more than one object at a time. Cross References Agnosia; Alexia; Cortical blindness; Optic aphasia; Prosopagnosia; Riddochs phenomenon; Simultanagnosia; Visual form agnosia Visual Disorientation Visual disorientation refers to the inability to perceive more than a fragment of the visual eld at any one time; it is sometimes characterized as a shifting frag- ment or island of clear vision. There may be difculty xating static visual stimuli and impaired visual pursuit eye movements.

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Assessment of additional risk factors including head trauma, allergies, diet, tobacco, and alcohol Patients with primary brain tumors can present with generalized or have also yielded conficting results with increased risk for developing focal signs and symptoms [30]. In parallel with these studies, exploration of later in the disease pathogenesis as the tumor grows and causes viral and genetic causes is burgeoning. Roughly 77% of all patients with primary brain tumors brain tumors is complex and unclear. Several viral families, including report a dull tension-type headache [31] that can persist for more than Polyomaviruses and Herpesviruses have been associated with brain six months in 50% of patients [4]. However, a study Seizures are common in patients with brain tumors with 15-95% of conducted by Strickler and colleagues showed no diference in the risk patients presenting with at least one seizure during the course of their of brain tumors between people who received vaccines contaminated illness [34]. Tumor involvement of the frontal, frontoparietal, temporal, and frontotemporal lobes were more ofen accompanied with seizures [35]. Finally, based on Genetics histological diagnosis, patients with mixed gliomas, Several inherited genetic syndromes have been associated with oligodendrogliomas, and astrocytomas experienced seizures at 62%, primary brain tumor development. Within the past decade we have seen imaging move from will be discussed in more detail in the vestibular schwannoma section. Continued advancements associated with benign tumors of the brain and other vital organs [19]. Tree approaches fall As the complexities of tumor genesis are discovered, new treatment within the image-guided resection modality and include intraoperative regimes will be designed. This unique integration allows surgeons to account for remains the general standard for identifcation of recurrent tumor brain shif and other anatomical changes that ofen afect maximal and/or its progression, new and old advanced imaging techniques are tumor debulking, particularly in eloquent areas of the brain. Variable success has been observed with these maximum safe resection while minimizing the amount of residual modalities and a rising school of thought is to assess the tumor both tumor cells [42]. Fluorescein is a fuorophore that can cross capillaries and provide fuoresce in the extracellular matrix [46]. Due to this property, Fluorescein is useful in identifying infltrative tumor margins [47]. This can be invaluable in guiding lesion complicated and no clear conclusions can be drawn [52]. Trombi are ofen found in these vessels and are Astrocytic Neoplasms responsible for the foci of necrosis. Astrocytomas, anaplastic astrocytomas, and glioblastomas are termed difusely infltrating astrocytomas due to their range of difuse Molecular Genetics infltration. The difuse astrocytic neoplasms are most common in the Although many important genetic alterations have been known in cerebrum in adults and brain stem in children [56]. They have a gliomas, new technologies have shed light onto novel discoveries in propensity for progression with 50%-75% of astrocytomas progressing recent years.

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This includes patients with spinal cord injury, stroke, neuromuscular disorder and amputees. These in essence are the patients for who, until now, the field of neurosurgery has not been able to offer any substantive intervention. With the increase in the survival rate of patients with stroke and trauma there is immense scope and opportunity for the field of neuromotor prosthesis. These devices hold tremendous affirmation for improving the quality of life of individuals who are cognitively intact yet motor impaired. Goals and working principle In a fundamental sense, paralysis restricts the ability of the individual to interact with their environment. These individuals may be cognitively normal and fully able to generate detailed movement plans using higher motor control structure but may not be able to convey these movement plans to actuality. Neuro-motor prosthesis aims to provide a useful surrogate action to return the ability for the individual to interact with their environment. These recognizes some form of electrophysiological alteration in the brain of the subject and use these changes as signal to either communicate with or control some element of the outside world that is consistent with the intention of the subject. An egregious example of such applications would be some type of brain signal controlling cursor on a computer screen, a prosthetic limb, or ones own limb. To achieve these goals and to transform it to actuality there are three major components of a neuromotor prosthesis. The physical brain machine interface comprises a neural implant which chronically records the activity of neurons in the brain. These recorded signals are sent to the decoding device, which decode that neural activity into intended movement signals. These signals in turn drive the third part of the neuromotor prosthetic, an output device for use by the patient whose neural activity is being decoded. All of these elements play in concert to manifest the users intention to his or her environment. Signal procecessing Digitized Device Signals comand Feature Translation Signal Acquisition extraction algorithm Feed back Brain Output device Fig. Neural commands for voluntary movement are essentially issued as electrical signals produced by the spiking and synaptic input of the individual. Signals related more directly to limb motion are present in a more limited, but still diverse, set of structures, including the cerebral cortex, thalamus, cerebellum and spinal cord. By being close to the surface, it allows ready access to electrical information via different signal acquisition technologies. The neural signal acquisition is done by electrodes, which recognizes these electrophysiological alterations in the brain of the subject. These electrodes can be either non- invasive, partially invasive or invasive in nature. The basic tradeoffs between these 3 electrodes are speed, degree of control and difficulty in recording. The non- invasive electrodes record neural signals from the scalp surface without penetrating neural tissue.

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The appropriate Government shall ensure that persons with disabilities have access to appropriate information regarding reproductive and family planning. The Election Commission of India and the State Election Commissions shall ensure that all polling stations are accessible to persons with disabilities and all materials related to the electoral process are easily understandable by and accessible to them. The appropriate Government shall ensure that persons with disabilities are able to exercise the right to access any court, tribunal, authority, commission or any other body having judicial or quasi-judicial or investigative powers without discrimination on the basis of disability. The appropriate Government shall ensure that the persons with disabilities have right, equally with others, to own or inherit property, movable or immovable, control their financial affairs and have access to bank loans, mortgages and other forms of financial credit. Notwithstanding anything contained in any other law for the time being in force, on and from the date of commencement of this Act, where a district court or any designated authority, as notified by the State Government, finds that a person with disability, who had been provided adequate and appropriate support but is unable to take legally binding decisions, may be provided further support of a limited guardian to take legally binding decisions on his behalf in consultation with such person, in such manner, as may be prescribed by the State Government. The appropriate Government shall designate one or more authorities to mobilise the community and create social awareness to support persons with disabilities in exercise of their legal capacity. It also, stipulates designation of special court at the district level for fast tracking cases of persons with disabilities under the Act. Thus the value and indispensability of experiential expertise also stands recognized. The Act provides for time-limit for compliance with some of its substantive provisions which includes provisions in respect of compliance with accessibility norms. Number of disabilities : the types of disabilities have been increased from existing 7 to 21 and the Central Government have the power to add the number of disabilities. Reservation: Incorporation of provisions concerning increase in percentage of reservation for the disabled in education and employment. Accessibility: Endorsement of enhanced accessibility for the disabled, in respect of infrastructure, technology, and information. Punishment: Acts of discrimination against the PwDs would now be treated as a criminal offence, and would be punished accordingly, with the establishment of special courts. The positives about these rules are that they have acted as supplements to the ongoing 'Sugamya Bharat Abhiyan" of the Department for Empowerment of Persons with Disabilities. Also, invitation of public comments on them signifies the intention of the government to elicit greater co-operation from the public in its endeavour. In order to exercise the powers conferred by sub-sections (1) and (2) of section 100 of the Rights of Persons with Disabilities Act, 2016 (49 of 2016), the Central Government notified the rules th on 15 June 2017. A nodal officer in the District Education Office be appointed to deal with all matters relating to admission of children with disabilities and the facilities to be provided to them in schools in accordance with the provisions of sections 16 and 31 of the Act. It also states that, if the aggrieved person submits a complaint to the Chief Commissioner or State Commissioner for Persons with Disabilities, as the case may be, the complaint shall be disposed of within a period of sixty days, provided that in exceptional cases, the Chief Commissioner or State Commissioner may dispose of such complaint within thirty days.