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The pathologic changes take the form of bilaterally symmetrical foci of spongy necrosis with myelin degeneration, vascular proliferation, and gliosis in the thalami, midbrain, pons, medulla, and spinal cord The basal ganglia are characteristically but not invariably affected Also, there may be a demyelinative type of peripheral neuropathy In their distribution and histologic appearance, the CNS lesions resemble those of Wernicke disease (due to a de ciency of thiamine) except that the lesions of Leigh disease are more extensive sometimes involving the striatum and they tend to spare the mammillary bodies The lesions, particularly those of the lenticular nuclei and brainstem, may be seen in CT scans and are strikingly demonstrated by MRI The histochemical appearance of muscle is normal, although electron microscopy may show an increased number of mitochondria The clinical boundaries of Leigh disease have not been de ned precisely.

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Create and insert blocks Rename, explode, and purge blocks Organize and insert blocks using the DesignCenter and Tool Palettes Window Add commands to a tool palette Insert a drawing le into the current drawing Create a drawing le from a block Copy and paste objects from drawing to drawing

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A familial disorder of infancy and early childhood referred to as bilateral striatial necrosis and associated with dystonia, visual failure, and other neurologic defects is probably a variant The same may be true of an obscure adult-onset syndrome of progressive dementia, due to thalamic lesions, in the form of necrosis, vascular proliferation, and gliosis The mitochondrial gene mutation most often associated with the Leigh disease is also discussed in relation to the NARP syndrome, below The close relationship between the two processes re-emphasizes the point that several mitochondrial mutations appear to give rise to the clinical and pathologic picture of a subacute necrotizing encephalopathy..

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College courses required in this eld usually include technical subjects, such as surveying, landscape design and construction, landscape ecology, site design, and urban and regional planning Other courses include history of landscape architecture, plant and soil science, geology, professional practice, and general management Many landscape architecture programs are adding courses that address environmental issues Most students at the undergraduate level take a year of prerequisite courses such as English, mathematics, and social and physical science The design studio is an important aspect of many landscape architecture curriculums Whenever possible, students are assigned real projects, providing them with valuable hands-on experience While working on these projects, students become more pro cient in CAD, GIS, and video simulation In 2008, forty-nine states required landscape architects to be licensed or registered.

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Licensing is based on the Landscape Architect Registration Examination (LARE), sponsored by the Council of Landscape Architectural Registration Boards (CLARB) and administered over a three-day period Exam admission usually requires a degree from an accredited school plus one to four years of work experience, though standards vary from state to state Currently, fteen states require the passage of a state examination in addition to the LARE to satisfy registration requirements State examinations, which are usually one hour and completed at the end of the LARE, focus on laws, environmental regulations, plants, soils, climate, and any other characteristics unique to the state Because state requirements for licensure are not uniform, landscape architects may not nd it easy to transfer their registration from one state to another.

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