const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Speech in Neurology";
pres.author = "Neurology Education";

// ── Design tokens ──────────────────────────────────────────────────────────────
const C = {
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  teal:    "1D7E8C",
  accent:  "E8F4F7",
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  gold:    "C8973A",
  lightLine: "D6E4EC",
  tableHead: "1B3A5C",
  tableAlt:  "EFF6FA",
};

const FONT = "Calibri";

// Helper: slide background
function bg(slide) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white }, line: { color: C.white } });
}

// Helper: left accent bar
function accentBar(slide, color) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: color || C.teal }, line: { color: color || C.teal } });
}

// Helper: slide header band
function headerBand(slide, label) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.95, fill: { color: C.navy }, line: { color: C.navy } });
  if (label) {
    slide.addText(label.toUpperCase(), {
      x: 0.3, y: 0, w: 9.4, h: 0.95,
      fontSize: 9, fontFace: FONT, color: "A8C8D8", bold: true,
      valign: "middle", charSpacing: 3,
    });
  }
}

// Helper: slide title below header
function slideTitle(slide, title, opts) {
  slide.addText(title, Object.assign({
    x: 0.3, y: 1.0, w: 9.4, h: 0.55,
    fontSize: 20, fontFace: FONT, bold: true, color: C.navy,
  }, opts || {}));
}

// Helper: divider line
function divider(slide, y) {
  slide.addShape(pres.ShapeType.line, { x: 0.3, y: y, w: 9.4, h: 0, line: { color: C.lightLine, width: 1 } });
}

// Helper: footer
function footer(slide, src) {
  slide.addText(src || "Bradley & Daroff's Neurology in Clinical Practice | DeJong's Neurological Examination", {
    x: 0.2, y: 5.3, w: 9.6, h: 0.28,
    fontSize: 7, fontFace: FONT, color: C.muted, italic: true, align: "center",
  });
}

// Helper: bullet block
function bullets(slide, items, opts) {
  const rows = items.map((item, i) => {
    if (typeof item === "string") {
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    }
    return item;
  });
  slide.addText(rows, Object.assign({ x: 0.4, y: 1.7, w: 9.2, h: 3.4 }, opts || {}));
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — Title slide
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  // Deep navy full background
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy }, line: { color: C.navy } });
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  // Teal accent strip bottom
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.5, w: 10, h: 0.125, fill: { color: C.teal }, line: { color: C.teal } });
  // Decorative circle (right side)
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  s.addShape(pres.ShapeType.ellipse, { x: 7.6, y: 0.9, w: 2.7, h: 2.7, fill: { color: "1B3A5C" }, line: { color: "1B3A5C" } });

  s.addText("SPEECH IN NEUROLOGY", {
    x: 0.5, y: 1.2, w: 7, h: 0.7,
    fontSize: 30, fontFace: FONT, bold: true, color: C.white, charSpacing: 2,
  });
  s.addText("Motor Speech Disorders & Aphasia", {
    x: 0.5, y: 1.95, w: 7, h: 0.5,
    fontSize: 16, fontFace: FONT, color: "A8C8D8", italic: false,
  });
  divider: s.addShape(pres.ShapeType.line, { x: 0.5, y: 2.55, w: 4.5, h: 0, line: { color: C.teal, width: 2 } });
  s.addText("For Neurology Residents", {
    x: 0.5, y: 2.7, w: 5, h: 0.35,
    fontSize: 12, fontFace: FONT, color: "7FAFC8",
  });
  s.addText("Based on Bradley & Daroff's Neurology in Clinical Practice\n& Adams and Victor's Principles of Neurology", {
    x: 0.5, y: 4.6, w: 9, h: 0.7,
    fontSize: 9, fontFace: FONT, color: "7FAFC8", italic: true,
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — Overview / outline
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Overview"); footer(s);
  slideTitle(s, "Topics Covered");
  divider(s, 1.62);

  const topics = [
    ["1", "Introduction — What is a Motor Speech Disorder?"],
    ["2", "Speech Examination at the Bedside"],
    ["3", "Dysarthria — Definition & Classification"],
    ["4", "Types of Dysarthria (Flaccid, Spastic, Ataxic)"],
    ["5", "Types of Dysarthria (Hypokinetic, Hyperkinetic, Mixed)"],
    ["6", "Apraxia of Speech"],
    ["7", "Oral / Buccolingual Apraxia"],
    ["8", "Rare Motor Speech Disorders"],
    ["9", "Aphasia — Introduction & Bedside Testing"],
    ["10", "Broca Aphasia"],
    ["11", "Wernicke Aphasia"],
    ["12", "Global Aphasia"],
    ["13", "Conduction Aphasia"],
    ["14", "Transcortical Aphasias & Anomic Aphasia"],
    ["15", "Aphasia Syndromes — Comparison Table"],
    ["16", "Localization of Lesions"],
    ["17", "Aphasia vs. Motor Speech Disorder"],
    ["18", "Management & Rehabilitation"],
    ["19", "Clinical Pearls"],
    ["20", "Key Takeaways"],
  ];

  // Two-column layout
  const col1 = topics.slice(0, 10);
  const col2 = topics.slice(10);

  const makeColItems = (arr) => arr.map((t, i) => [
    { text: t[0] + ".", options: { bold: true, color: C.teal, fontSize: 11, fontFace: FONT } },
    { text: "  " + t[1], options: { color: C.text, fontSize: 11, fontFace: FONT, breakLine: i < arr.length - 1 } },
  ]).flat();

  s.addText(makeColItems(col1), { x: 0.35, y: 1.75, w: 4.5, h: 3.5 });
  s.addText(makeColItems(col2), { x: 5.1, y: 1.75, w: 4.5, h: 3.5 });
  // Vertical divider
  s.addShape(pres.ShapeType.line, { x: 5.0, y: 1.75, w: 0, h: 3.5, line: { color: C.lightLine, width: 1 } });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — Introduction: Motor Speech Disorders
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Introduction"); footer(s);
  slideTitle(s, "Motor Speech Disorders — Key Concepts");
  divider(s, 1.62);

  s.addText([
    { text: "Definition", options: { bold: true, color: C.teal, fontSize: 14, fontFace: FONT, breakLine: true } },
    { text: "Syndromes of abnormal articulation WITHOUT abnormalities of language", options: { color: C.text, fontSize: 13, fontFace: FONT, breakLine: true, paraSpaceAfter: 8 } },
    { text: "Core rule: ", options: { bold: true, color: C.navy, fontSize: 13, fontFace: FONT } },
    { text: "If you transcribe the patient's speech into text → it reads as normal language", options: { color: C.text, fontSize: 13, fontFace: FONT, breakLine: true, paraSpaceAfter: 8 } },
    { text: "Conditions preserved in motor speech disorders:", options: { bold: true, color: C.navy, fontSize: 13, fontFace: FONT, breakLine: true } },
    { text: "Normal expressive language in writing", options: { bullet: { code: "2022", color: C.teal }, color: C.text, fontSize: 12, fontFace: FONT, indentLevel: 1, breakLine: true } },
    { text: "Normal comprehension of spoken and written language", options: { bullet: { code: "2022", color: C.teal }, color: C.text, fontSize: 12, fontFace: FONT, indentLevel: 1, breakLine: true, paraSpaceAfter: 8 } },
    { text: "Categories (Bradley & Daroff, Ch.14):", options: { bold: true, color: C.navy, fontSize: 13, fontFace: FONT, breakLine: true } },
    { text: "Dysarthrias (46.3% of speech/language disorders at Mayo Clinic)", options: { bullet: { code: "2022", color: C.teal }, color: C.text, fontSize: 12, fontFace: FONT, indentLevel: 1, breakLine: true } },
    { text: "Apraxia of Speech (4.6%)", options: { bullet: { code: "2022", color: C.teal }, color: C.text, fontSize: 12, fontFace: FONT, indentLevel: 1, breakLine: true } },
    { text: "Rare syndromes: Aphemia, Foreign Accent Syndrome, Acquired Stuttering, Opercular Syndrome", options: { bullet: { code: "2022", color: C.teal }, color: C.text, fontSize: 12, fontFace: FONT, indentLevel: 1 } },
  ], { x: 0.35, y: 1.7, w: 9.3, h: 3.65 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — Bedside Examination of Speech
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Examination"); footer(s);
  slideTitle(s, "Bedside Speech Examination");
  divider(s, 1.62);

  // 2-column layout: what to test vs what to observe
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.7, w: 4.45, h: 3.5, fill: { color: C.accent }, line: { color: C.lightLine } });
  s.addShape(pres.ShapeType.rect, { x: 5.3, y: 1.7, w: 4.45, h: 3.5, fill: { color: "F0FBF5" }, line: { color: C.lightLine } });

  s.addText("What to Test", { x: 0.3, y: 1.72, w: 4.3, h: 0.4, fontSize: 13, fontFace: FONT, bold: true, color: C.navy });
  s.addText([
    { text: "Repeat syllables, words, sentences", options: { bullet: true, breakLine: true, fontSize: 12, fontFace: FONT, color: C.text } },
    { text: "Single consonant repetition  /p/, /p/, /p/", options: { bullet: true, breakLine: true, fontSize: 12, fontFace: FONT, color: C.text } },
    { text: "Consonant shift  /p/, /t/, /k/ (diadochokinesis)", options: { bullet: true, breakLine: true, fontSize: 12, fontFace: FONT, color: C.text } },
    { text: "Polysyllabic words: 'catastrophe', 'television'", options: { bullet: true, breakLine: true, fontSize: 12, fontFace: FONT, color: C.text } },
    { text: "Repeat same word 5× → reveals inconsistency in apraxia", options: { bullet: true, breakLine: true, fontSize: 12, fontFace: FONT, color: C.text } },
    { text: "Fluency, comprehension, naming, repetition, reading, writing (aphasia battery)", options: { bullet: true, fontSize: 12, fontFace: FONT, color: C.text } },
  ], { x: 0.35, y: 2.15, w: 4.2, h: 3.0 });

  s.addText("What to Observe", { x: 5.35, y: 1.72, w: 4.3, h: 0.4, fontSize: 13, fontFace: FONT, bold: true, color: C.navy });
  s.addText([
    { text: "Rate & rhythm (slow, fast, irregular)", options: { bullet: true, breakLine: true, fontSize: 12, fontFace: FONT, color: C.text } },
    { text: "Voice quality (harsh, breathy, nasal, strained)", options: { bullet: true, breakLine: true, fontSize: 12, fontFace: FONT, color: C.text } },
    { text: "Articulation (consonant distortion vs. substitution)", options: { bullet: true, breakLine: true, fontSize: 12, fontFace: FONT, color: C.text } },
    { text: "Prosody / melody", options: { bullet: true, breakLine: true, fontSize: 12, fontFace: FONT, color: C.text } },
    { text: "Consistency of errors (consistent = dysarthria; inconsistent = apraxia)", options: { bullet: true, breakLine: true, fontSize: 12, fontFace: FONT, color: C.text } },
    { text: "Associated signs: facial droop, tongue weakness, palatal movement, jaw jerk, gag reflex", options: { bullet: true, fontSize: 12, fontFace: FONT, color: C.text } },
  ], { x: 5.4, y: 2.15, w: 4.2, h: 3.0 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — Dysarthria: Definition & Classification
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Motor Speech — Dysarthria"); footer(s);
  slideTitle(s, "Dysarthria — Definition & Classification");
  divider(s, 1.62);

  s.addText([
    { text: "Definition ", options: { bold: true, color: C.teal, fontSize: 14, fontFace: FONT } },
    { text: "(Duffy, 1995)", options: { italic: true, color: C.muted, fontSize: 12, fontFace: FONT, breakLine: true } },
    { text: "Abnormal neuromuscular activation of speech muscles affecting speed, strength, timing, range, or accuracy. Most consistent finding: ", options: { color: C.text, fontSize: 12, fontFace: FONT } },
    { text: "distortion of consonant sounds.", options: { bold: true, color: C.navy, fontSize: 12, fontFace: FONT, breakLine: true, paraSpaceAfter: 6 } },
    { text: "Neurogenic", options: { bold: true, color: C.navy, fontSize: 12, fontFace: FONT } },
    { text: " — CNS, PNS, NMJ, or muscle dysfunction (NOT local structural palate/tongue/larynx problems)", options: { color: C.text, fontSize: 12, fontFace: FONT, breakLine: true, paraSpaceAfter: 6 } },
    { text: "Affected domains: ", options: { bold: true, color: C.navy, fontSize: 12, fontFace: FONT } },
    { text: "Articulation • Phonation • Breathing • Prosody", options: { color: C.text, fontSize: 12, fontFace: FONT, breakLine: true, paraSpaceAfter: 6 } },
    { text: "Complete loss of articulation = ", options: { color: C.text, fontSize: 12, fontFace: FONT } },
    { text: "Anarthria", options: { bold: true, color: C.teal, fontSize: 12, fontFace: FONT, breakLine: true, paraSpaceAfter: 8 } },
    { text: "Mayo Clinic Classification (Duffy, 1995) — 6 Types:", options: { bold: true, color: C.navy, fontSize: 13, fontFace: FONT, breakLine: true } },
  ], { x: 0.35, y: 1.7, w: 9.3, h: 2.2 });

  // 6-box grid
  const types = [
    { label: "Flaccid", sublabel: "LMN / NMJ / Muscle", color: "E8F4F7" },
    { label: "Spastic", sublabel: "Bilateral UMN", color: "EDF7ED" },
    { label: "Ataxic", sublabel: "Cerebellum", color: "FFF8E8" },
    { label: "Hypokinetic", sublabel: "Basal Ganglia (PD)", color: "F7EEF7" },
    { label: "Hyperkinetic", sublabel: "Basal Ganglia", color: "FEF3F0" },
    { label: "Mixed", sublabel: "Multiple systems", color: "F0F0F7" },
  ];
  types.forEach((t, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.3 + col * 3.15;
    const y = 3.85 + row * 0.85;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 3.0, h: 0.75, fill: { color: t.color }, line: { color: C.lightLine }, rectRadius: 0.05 });
    s.addText(t.label, { x: x + 0.1, y: y + 0.03, w: 2.8, h: 0.35, fontSize: 13, fontFace: FONT, bold: true, color: C.navy });
    s.addText(t.sublabel, { x: x + 0.1, y: y + 0.38, w: 2.8, h: 0.3, fontSize: 10, fontFace: FONT, color: C.muted });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — Dysarthria Types Part 1 (Flaccid, Spastic, Ataxic)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Dysarthria Types (1/2)"); footer(s);
  slideTitle(s, "Flaccid • Spastic • Ataxic Dysarthria");
  divider(s, 1.62);

  const rowData = [
    { type: "Flaccid", lesion: "LMN, NMJ, muscle", speech: "Breathy, nasal; indistinct consonants; fatigable", examples: "MG, polymyositis, bulbar polio, GBS", color: "E8F4F7" },
    { type: "Spastic", lesion: "Bilateral corticobulbar / motor cortex", speech: "Harsh, 'strain-strangle'; slow rate; low pitch; consonant errors", examples: "Bilateral strokes, ALS (pseudobulbar palsy)", color: "EDF7ED" },
    { type: "Unilateral UMN", lesion: "Unilateral UMN lesion", speech: "Milder spastic pattern; very common after unilateral stroke", examples: "Unilateral hemispheric stroke", color: "F5F7ED" },
    { type: "Ataxic", lesion: "Cerebellum", speech: "'Scanning speech': explosive syllables with pauses OR equal stress on every syllable; irregular /p/ repetition", examples: "MS, cerebellar ataxias, alcohol", color: "FFF8E8" },
  ];

  // Header row
  const headers = ["Type", "Lesion Site", "Speech Character", "Causes"];
  const colW = [1.5, 2.2, 3.5, 2.3];
  const startX = [0.25, 1.8, 4.05, 7.6];
  const headerY = 1.72;

  headers.forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x: startX[i], y: headerY, w: colW[i], h: 0.4, fill: { color: C.navy }, line: { color: C.navy } });
    s.addText(h, { x: startX[i] + 0.05, y: headerY, w: colW[i] - 0.1, h: 0.4, fontSize: 11, fontFace: FONT, bold: true, color: C.white, valign: "middle" });
  });

  rowData.forEach((r, ri) => {
    const y = 2.15 + ri * 0.78;
    const vals = [r.type, r.lesion, r.speech, r.examples];
    vals.forEach((v, ci) => {
      s.addShape(pres.ShapeType.rect, { x: startX[ci], y, w: colW[ci], h: 0.76, fill: { color: ri % 2 === 0 ? r.color : "FAFCFF" }, line: { color: C.lightLine } });
      s.addText(v, { x: startX[ci] + 0.05, y: y + 0.05, w: colW[ci] - 0.1, h: 0.66, fontSize: 10, fontFace: FONT, color: ci === 0 ? C.navy : C.text, bold: ci === 0, valign: "middle" });
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — Dysarthria Types Part 2 (Hypokinetic, Hyperkinetic, Mixed)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Dysarthria Types (2/2)"); footer(s);
  slideTitle(s, "Hypokinetic • Hyperkinetic • Mixed Dysarthria");
  divider(s, 1.62);

  // Hypokinetic box
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.7, w: 4.55, h: 1.7, fill: { color: "F7EEF7" }, line: { color: C.lightLine } });
  s.addText("Hypokinetic Dysarthria", { x: 0.35, y: 1.72, w: 4.3, h: 0.38, fontSize: 13, fontFace: FONT, bold: true, color: C.navy });
  s.addText([
    { text: "Lesion: ", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT } },
    { text: "Basal ganglia (especially substantia nigra → Parkinson disease)", options: { color: C.text, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: "Speech: ", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT } },
    { text: "Hypophonic (very soft), rapid rate (festination of speech), monotone, reduced loudness, mumbling", options: { color: C.text, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: "Also: ", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT } },
    { text: "Progressive supranuclear palsy, MSA", options: { color: C.text, fontSize: 11, fontFace: FONT } },
  ], { x: 0.35, y: 2.12, w: 4.3, h: 1.25 });

  // Hyperkinetic box
  s.addShape(pres.ShapeType.rect, { x: 5.2, y: 1.7, w: 4.55, h: 1.7, fill: { color: "FEF3F0" }, line: { color: C.lightLine } });
  s.addText("Hyperkinetic Dysarthria", { x: 5.3, y: 1.72, w: 4.3, h: 0.38, fontSize: 13, fontFace: FONT, bold: true, color: C.navy });
  s.addText([
    { text: "Lesion: ", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT } },
    { text: "Basal ganglia (abnormal involuntary movements)", options: { color: C.text, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: "Speech: ", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT } },
    { text: "Involuntary intrusions, variable rate & pitch, voice arrests, excess loudness variations", options: { color: C.text, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: "Also: ", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT } },
    { text: "Huntington disease, dystonia, Tourette's, myoclonus", options: { color: C.text, fontSize: 11, fontFace: FONT } },
  ], { x: 5.3, y: 2.12, w: 4.3, h: 1.25 });

  // Mixed box
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 3.55, w: 9.5, h: 1.5, fill: { color: "F0F0F7" }, line: { color: C.lightLine } });
  s.addText("Mixed Dysarthria", { x: 0.35, y: 3.57, w: 9.2, h: 0.38, fontSize: 13, fontFace: FONT, bold: true, color: C.navy });
  s.addText([
    { text: "Combination of two or more dysarthria types. Most important examples:", options: { color: C.text, fontSize: 12, fontFace: FONT, breakLine: true } },
    { text: "ALS: ", options: { bold: true, color: C.navy, fontSize: 12, fontFace: FONT } },
    { text: "Mixed spastic + flaccid (bulbar + pseudobulbar features simultaneously)", options: { color: C.text, fontSize: 12, fontFace: FONT, breakLine: true } },
    { text: "Wilson disease: ", options: { bold: true, color: C.navy, fontSize: 12, fontFace: FONT } },
    { text: "Mixed spastic + ataxic + hypokinetic", options: { color: C.text, fontSize: 12, fontFace: FONT, breakLine: true } },
    { text: "Multiple strokes: ", options: { bold: true, color: C.navy, fontSize: 12, fontFace: FONT } },
    { text: "Any combination depending on lesion locations", options: { color: C.text, fontSize: 12, fontFace: FONT } },
  ], { x: 0.35, y: 3.97, w: 9.2, h: 1.0 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — Apraxia of Speech
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Motor Speech — Apraxia of Speech"); footer(s);
  slideTitle(s, "Apraxia of Speech");
  divider(s, 1.62);

  s.addText([
    { text: "Definition: ", options: { bold: true, color: C.teal, fontSize: 13, fontFace: FONT } },
    { text: "Disorder of programing articulation of sequences of phonemes — no weakness, slowness or incoordination of speech muscles. Patient ", options: { color: C.text, fontSize: 13, fontFace: FONT } },
    { text: '"knows what they want to say and how it should sound" yet cannot articulate it properly', options: { italic: true, color: C.navy, fontSize: 12, fontFace: FONT, breakLine: true, paraSpaceAfter: 6 } },
  ], { x: 0.35, y: 1.7, w: 9.3, h: 0.8 });

  // 4-cardinal features in boxes
  s.addText("4 Cardinal Features:", { x: 0.35, y: 2.55, w: 9.3, h: 0.35, fontSize: 13, fontFace: FONT, bold: true, color: C.navy });

  const features = [
    { num: "1", text: "Effortful, groping 'trial-and-error' attempts with self-correction" },
    { num: "2", text: "Dysprosody (abnormal melody of speech)" },
    { num: "3", text: "Inconsistent articulation errors (≠ dysarthria)" },
    { num: "4", text: "Difficulty initiating utterances — worst on first phoneme of polysyllabic words" },
  ];

  features.forEach((f, i) => {
    const x = 0.25 + (i % 2) * 4.85;
    const y = 3.0 + Math.floor(i / 2) * 0.82;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.65, h: 0.72, fill: { color: C.accent }, line: { color: C.lightLine } });
    s.addShape(pres.ShapeType.ellipse, { x: x + 0.1, y: y + 0.14, w: 0.44, h: 0.44, fill: { color: C.teal }, line: { color: C.teal } });
    s.addText(f.num, { x: x + 0.1, y: y + 0.14, w: 0.44, h: 0.44, fontSize: 12, fontFace: FONT, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(f.text, { x: x + 0.65, y: y + 0.08, w: 3.9, h: 0.56, fontSize: 11, fontFace: FONT, color: C.text, valign: "middle" });
  });

  s.addText([
    { text: "Localization: ", options: { bold: true, color: C.navy, fontSize: 12, fontFace: FONT } },
    { text: "Left hemisphere insula (Dronkers, 1996) and/or Broca area (Hillis et al., 2004)  |  ", options: { color: C.text, fontSize: 11, fontFace: FONT } },
    { text: "Bedside test: ", options: { bold: true, color: C.navy, fontSize: 12, fontFace: FONT } },
    { text: "Repeat 'catastrophe' or 'television' 5× — inconsistent errors emerge", options: { color: C.text, fontSize: 11, fontFace: FONT } },
  ], { x: 0.35, y: 4.7, w: 9.3, h: 0.4 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — Apraxia vs Dysarthria + Oral Apraxia
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Comparison"); footer(s);
  slideTitle(s, "Apraxia of Speech vs. Dysarthria");
  divider(s, 1.62);

  const rows = [
    ["Feature", "Apraxia of Speech", "Dysarthria"],
    ["Error type", "Consonant substitutions", "Consonant distortions"],
    ["Consistency", "Inconsistent (trial to trial)", "Consistent"],
    ["Weakness", "Absent", "Often present (flaccid/spastic)"],
    ["Prosody", "Dysprosodic", "Variable"],
    ["First phoneme", "Most difficult", "Not specifically"],
    ["Repetition", "Errors worsen on repetition", "Consistent pattern"],
    ["Writing", "Better than speaking (usually)", "Not specifically affected"],
    ["Lesion", "Left insula / Broca area", "Varies by type"],
  ];

  const colW2 = [2.5, 3.2, 3.2];
  const startX2 = [0.25, 2.8, 6.05];
  rows.forEach((row, ri) => {
    const y = 1.72 + ri * 0.41;
    const isHeader = ri === 0;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, {
        x: startX2[ci], y, w: colW2[ci], h: 0.39,
        fill: { color: isHeader ? C.navy : (ri % 2 === 0 ? C.accent : C.white) },
        line: { color: C.lightLine },
      });
      s.addText(cell, {
        x: startX2[ci] + 0.06, y: y + 0.03, w: colW2[ci] - 0.12, h: 0.33,
        fontSize: isHeader ? 11 : 10, fontFace: FONT,
        bold: isHeader || ci === 0, color: isHeader ? C.white : (ci === 0 ? C.navy : C.text),
        valign: "middle",
      });
    });
  });

  s.addText("Oral/Buccolingual Apraxia (distinct from Apraxia of Speech)", { x: 0.25, y: 5.15, w: 9.5, h: 0.28, fontSize: 10, fontFace: FONT, bold: true, color: C.teal });
  s.addText("Test: Ask patient to lick upper lip, smile, stick out tongue voluntarily. Both oral apraxia and apraxia of speech can coexist with Broca aphasia.", { x: 0.25, y: 5.35, w: 9.5, h: 0.22, fontSize: 9, fontFace: FONT, color: C.text });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — Rare Motor Speech Disorders
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Rare Motor Speech Disorders"); footer(s);
  slideTitle(s, "Aphemia • Foreign Accent Syndrome • Acquired Stuttering • Opercular Syndrome");
  divider(s, 1.62);

  const rare = [
    {
      name: "Aphemia",
      text: "Near muteness with normal comprehension, reading, and writing. Clearly motor — NOT aphasia. Patient is often anarthric, then effortful non-fluent speech emerges. Lesion: face area of motor cortex / Broca area vicinity.",
      color: C.accent,
    },
    {
      name: "Foreign Accent Syndrome",
      text: 'Acquired dysfluency resembling a foreign accent. Usually after unilateral stroke involving left motor cortex. Can be mixed with aphasia.',
      color: "EDF7ED",
    },
    {
      name: "Acquired Stuttering",
      text: "Hesitancy producing initial phonemes + dysrhythmia. Overlaps with apraxia of speech. Left hemisphere cortical strokes most common; also subcortical (pons, basal ganglia, white matter). May also be psychogenic.",
      color: "FFF8E8",
    },
    {
      name: "Opercular Syndrome (Foix-Chavany-Marie)",
      text: "Bilateral perisylvian cortex/subcortical lesions → complete mutism. Can follow limb commands but cannot voluntarily move cranial muscles. Key feature: automatic-voluntary dissociation (smile when amused, yawn spontaneously — but cannot open mouth on command).",
      color: "FEF3F0",
    },
  ];

  rare.forEach((r, i) => {
    const x = i % 2 === 0 ? 0.25 : 5.2;
    const y = i < 2 ? 1.72 : 3.5;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.55, h: 1.65, fill: { color: r.color }, line: { color: C.lightLine } });
    s.addText(r.name, { x: x + 0.1, y: y + 0.05, w: 4.3, h: 0.38, fontSize: 12, fontFace: FONT, bold: true, color: C.navy });
    s.addText(r.text, { x: x + 0.1, y: y + 0.45, w: 4.35, h: 1.1, fontSize: 10, fontFace: FONT, color: C.text });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — Aphasia Introduction
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Aphasia"); footer(s);
  slideTitle(s, "Aphasia — Introduction & Bedside Testing");
  divider(s, 1.62);

  s.addText([
    { text: "Definition: ", options: { bold: true, color: C.teal, fontSize: 14, fontFace: FONT } },
    { text: "Acquired disorder of language (not speech mechanics) due to brain injury. 27.1% of speech/language disorders at Mayo Clinic.", options: { color: C.text, fontSize: 13, fontFace: FONT, breakLine: true, paraSpaceAfter: 8 } },
    { text: "Bedside Language Battery (6 domains):", options: { bold: true, color: C.navy, fontSize: 13, fontFace: FONT, breakLine: true } },
  ], { x: 0.35, y: 1.72, w: 9.3, h: 1.05 });

  const domains = [
    { label: "Spontaneous Speech", note: "Fluent vs. Non-fluent; agrammatic/telegraphic vs. paraphasic", icon: "1" },
    { label: "Naming", note: "Confrontation naming; word-finding; paraphasic errors", icon: "2" },
    { label: "Comprehension", note: "Yes/no questions; follow commands; complex syntax", icon: "3" },
    { label: "Repetition", note: "Single words → phrases → sentences", icon: "4" },
    { label: "Reading", note: "Aloud and for comprehension (may dissociate)", icon: "5" },
    { label: "Writing", note: "Assess independently of motor weakness", icon: "6" },
  ];

  domains.forEach((d, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.25 + col * 3.18;
    const y = 2.85 + row * 0.88;
    s.addShape(pres.ShapeType.rect, { x, y, w: 3.05, h: 0.78, fill: { color: row === 0 ? C.accent : "EDF7ED" }, line: { color: C.lightLine } });
    s.addShape(pres.ShapeType.ellipse, { x: x + 0.08, y: y + 0.16, w: 0.38, h: 0.38, fill: { color: C.navy }, line: { color: C.navy } });
    s.addText(d.icon, { x: x + 0.08, y: y + 0.16, w: 0.38, h: 0.38, fontSize: 10, fontFace: FONT, bold: true, color: C.white, align: "center", valign: "middle" });
    s.addText(d.label, { x: x + 0.55, y: y + 0.04, w: 2.4, h: 0.3, fontSize: 11, fontFace: FONT, bold: true, color: C.navy });
    s.addText(d.note, { x: x + 0.55, y: y + 0.38, w: 2.4, h: 0.36, fontSize: 9, fontFace: FONT, color: C.text });
  });

  s.addText("Clinical tip: Associated neurological signs (hemiparesis, visual field defects, sensory loss) help classify aphasia type and localize lesion.", {
    x: 0.3, y: 5.2, w: 9.4, h: 0.3, fontSize: 9.5, fontFace: FONT, color: C.muted, italic: true,
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — Broca Aphasia
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Aphasia — Broca"); footer(s);
  slideTitle(s, "Broca Aphasia");
  divider(s, 1.62);

  // Left column: features
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.7, w: 5.1, h: 3.65, fill: { color: C.accent }, line: { color: C.lightLine } });
  s.addText("Bedside Features (Table 13.1)", { x: 0.35, y: 1.72, w: 4.9, h: 0.38, fontSize: 12, fontFace: FONT, bold: true, color: C.navy });
  const brocaRows = [
    ["Spontaneous speech", "Nonfluent, mute, or telegraphic; agrammatic; ± dysarthric"],
    ["Naming", "Impaired; tip-of-tongue phenomenon common"],
    ["Comprehension", "Relatively intact (mild difficulty with complex syntax)"],
    ["Repetition", "Impaired (hesitant, resembles spontaneous speech)"],
    ["Reading", "Often impaired ('third alexia')"],
    ["Writing", "Impaired (dysmorphic, dysgrammatical)"],
    ["Associated", "Right hemiparesis, hemisensory loss, ± left limb apraxia"],
  ];
  brocaRows.forEach((r, i) => {
    const y = 2.15 + i * 0.44;
    s.addText(r[0] + ":", { x: 0.35, y, w: 1.6, h: 0.38, fontSize: 9.5, fontFace: FONT, bold: true, color: C.navy, valign: "middle" });
    s.addText(r[1], { x: 2.0, y, w: 3.2, h: 0.38, fontSize: 9.5, fontFace: FONT, color: C.text, valign: "middle" });
  });

  // Right column: key pearls
  s.addText("Clinical Pearls", { x: 5.6, y: 1.72, w: 4.1, h: 0.38, fontSize: 12, fontFace: FONT, bold: true, color: C.navy });
  s.addText([
    { text: "Agrammatism / telegraphic speech:", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: '"wife come hospital" — nouns/verbs preserved, grammatical words omitted', options: { italic: true, color: C.teal, fontSize: 11, fontFace: FONT, breakLine: true, paraSpaceAfter: 5 } },
    { text: "Phonemic paraphasias:", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: "Substitutions closely resemble target (p for b); inconsistent", options: { color: C.text, fontSize: 11, fontFace: FONT, breakLine: true, paraSpaceAfter: 5 } },
    { text: "Lesion:", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: "Left inferior frontal gyrus (Broca area — BA 44/45) ± adjacent motor cortex", options: { color: C.text, fontSize: 11, fontFace: FONT, breakLine: true, paraSpaceAfter: 5 } },
    { text: "Psychiatric:", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: "Frequent depression; patients are aware of and frustrated by their deficits", options: { color: C.text, fontSize: 11, fontFace: FONT, breakLine: true, paraSpaceAfter: 5 } },
    { text: "Historic note:", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: 'Paul Broca (1861) — patient who could only say "tan"', options: { italic: true, color: C.muted, fontSize: 11, fontFace: FONT } },
  ], { x: 5.6, y: 2.15, w: 4.1, h: 3.2 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — Wernicke Aphasia
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Aphasia — Wernicke"); footer(s);
  slideTitle(s, "Wernicke Aphasia");
  divider(s, 1.62);

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.7, w: 5.1, h: 3.65, fill: { color: "EDF7ED" }, line: { color: C.lightLine } });
  s.addText("Bedside Features (Table 13.2)", { x: 0.35, y: 1.72, w: 4.9, h: 0.38, fontSize: 12, fontFace: FONT, bold: true, color: C.navy });
  const werRows = [
    ["Spontaneous speech", "Fluent, ± logorrhoeic; paraphasias, neologisms, jargon; NOT dysarthric"],
    ["Naming", "Impaired (bizarre paraphasic substitutions)"],
    ["Comprehension", "Impaired (even for simple questions)"],
    ["Repetition", "Impaired"],
    ["Reading", "Impaired (comprehension similarly affected)"],
    ["Writing", "Well-formed but paragraphic (spelling errors)"],
    ["Associated", "± Right hemianopia; NO hemiparesis usually"],
  ];
  werRows.forEach((r, i) => {
    const y = 2.15 + i * 0.44;
    s.addText(r[0] + ":", { x: 0.35, y, w: 1.6, h: 0.38, fontSize: 9.5, fontFace: FONT, bold: true, color: C.navy, valign: "middle" });
    s.addText(r[1], { x: 2.0, y, w: 3.2, h: 0.38, fontSize: 9.5, fontFace: FONT, color: C.text, valign: "middle" });
  });

  s.addText("Clinical Pearls", { x: 5.6, y: 1.72, w: 4.1, h: 0.38, fontSize: 12, fontFace: FONT, bold: true, color: C.navy });
  s.addText([
    { text: "Fluent but empty speech:", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: "A speaker of a foreign language might notice nothing amiss, but a native listener detects meaningless speech", options: { italic: true, color: C.teal, fontSize: 11, fontFace: FONT, breakLine: true, paraSpaceAfter: 5 } },
    { text: "Lesion:", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: "Posterior superior temporal gyrus (Wernicke area — BA 22) ± inferior parietal lobe and middle temporal gyrus", options: { color: C.text, fontSize: 11, fontFace: FONT, breakLine: true, paraSpaceAfter: 5 } },
    { text: "Psychiatric:", options: { bold: true, color: C.navy, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: "Often unaware/unconcerned about deficits; may become angry/paranoid over time", options: { color: C.text, fontSize: 11, fontFace: FONT, breakLine: true, paraSpaceAfter: 5 } },
    { text: "Danger:", options: { bold: true, color: C.gold, fontSize: 11, fontFace: FONT, breakLine: true } },
    { text: "May be misdiagnosed as psychosis due to fluent jargon — look for temporal lobe stroke signs, no hemiplegia", options: { color: C.text, fontSize: 11, fontFace: FONT } },
  ], { x: 5.6, y: 2.15, w: 4.1, h: 3.2 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — Global Aphasia
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Aphasia — Global"); footer(s);
  slideTitle(s, "Global Aphasia");
  divider(s, 1.62);

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.7, w: 4.5, h: 3.4, fill: { color: "FEF3F0" }, line: { color: C.lightLine } });
  s.addText("Bedside Features (Table 13.3)", { x: 0.35, y: 1.72, w: 4.2, h: 0.38, fontSize: 12, fontFace: FONT, bold: true, color: C.navy });
  const globalRows = [
    ["Spontaneous speech", "Mute or severely nonfluent"],
    ["Naming", "Impaired"],
    ["Comprehension", "Impaired"],
    ["Repetition", "Impaired"],
    ["Reading", "Impaired"],
    ["Writing", "Impaired"],
    ["Associated", "Right hemiparesis + hemisensory loss + hemianopia"],
  ];
  globalRows.forEach((r, i) => {
    const y = 2.15 + i * 0.41;
    s.addText(r[0] + ":", { x: 0.35, y, w: 1.5, h: 0.36, fontSize: 9.5, fontFace: FONT, bold: true, color: C.navy, valign: "middle" });
    s.addText(r[1], { x: 1.9, y, w: 2.7, h: 0.36, fontSize: 9.5, fontFace: FONT, color: C.text, valign: "middle" });
  });

  s.addText("Key Points", { x: 5.0, y: 1.72, w: 4.7, h: 0.38, fontSize: 12, fontFace: FONT, bold: true, color: C.navy });
  s.addText([
    { text: "= Broca + Wernicke deficits combined", options: { bold: true, color: C.teal, fontSize: 12, fontFace: FONT, breakLine: true, paraSpaceAfter: 6 } },
    { text: "Lesion: ", options: { bold: true, color: C.navy, fontSize: 12, fontFace: FONT } },
    { text: "Large left MCA territory — inferior frontal + superior temporal + parietal", options: { color: C.text, fontSize: 12, fontFace: FONT, breakLine: true, paraSpaceAfter: 6 } },
    { text: "Recovery: ", options: { bold: true, color: C.navy, fontSize: 12, fontFace: FONT } },
    { text: "If superior temporal gyrus spared → may evolve toward Broca aphasia. Second 6 months may show MORE recovery than first 6 months.", options: { color: C.text, fontSize: 12, fontFace: FONT, breakLine: true, paraSpaceAfter: 6 } },
    { text: "If milder — termed 'mixed aphasia' (all modalities impaired but not as severely as global)", options: { color: C.muted, fontSize: 11, fontFace: FONT, italic: true } },
  ], { x: 5.0, y: 2.15, w: 4.7, h: 2.7 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 — Conduction Aphasia
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Aphasia — Conduction"); footer(s);
  slideTitle(s, "Conduction Aphasia");
  divider(s, 1.62);

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.7, w: 4.5, h: 3.4, fill: { color: "F5F0FF" }, line: { color: C.lightLine } });
  s.addText("Bedside Features (Table 13.4)", { x: 0.35, y: 1.72, w: 4.2, h: 0.38, fontSize: 12, fontFace: FONT, bold: true, color: C.navy });
  const condRows = [
    ["Spontaneous speech", "Fluent with literal paraphasias and self-correction pauses"],
    ["Naming", "Moderately impaired"],
    ["Comprehension", "Intact"],
    ["Repetition", "SEVERELY impaired (hallmark)"],
    ["Reading aloud", "Moderately impaired; comprehension largely intact"],
    ["Writing", "Variable deficits"],
    ["Associated", "± Apraxia left limbs; ± mild right hemiparesis; ± right hemisensory loss; ± right hemianopia"],
  ];
  condRows.forEach((r, i) => {
    const y = 2.15 + i * 0.41;
    s.addText(r[0] + ":", { x: 0.35, y, w: 1.5, h: 0.36, fontSize: 9.5, fontFace: FONT, bold: r[0] === "Repetition", color: r[0] === "Repetition" ? C.teal : C.navy, valign: "middle" });
    s.addText(r[1], { x: 1.9, y, w: 2.7, h: 0.36, fontSize: 9.5, fontFace: FONT, color: C.text, valign: "middle" });
  });

  s.addText("Key Points", { x: 5.0, y: 1.72, w: 4.7, h: 0.38, fontSize: 12, fontFace: FONT, bold: true, color: C.navy });
  s.addText([
    { text: "Hallmark:", options: { bold: true, color: C.teal, fontSize: 13, fontFace: FONT, breakLine: true } },
    { text: "Disproportionately impaired repetition despite intact comprehension and relatively fluent speech", options: { color: C.text, fontSize: 12, fontFace: FONT, breakLine: true, paraSpaceAfter: 6 } },
    { text: "Classic example:", options: { bold: true, color: C.navy, fontSize: 12, fontFace: FONT, breakLine: true } },
    { text: "Cannot repeat 'boy' but says 'I like girls better'", options: { italic: true, color: C.teal, fontSize: 12, fontFace: FONT, breakLine: true, paraSpaceAfter: 6 } },
    { text: "Lesion:", options: { bold: true, color: C.navy, fontSize: 12, fontFace: FONT, breakLine: true } },
    { text: "Superior temporal or inferior parietal region (arcuate fasciculus disconnection). Parietal lesion → often with limb apraxia; Temporal lesion → without apraxia.", options: { color: C.text, fontSize: 12, fontFace: FONT, breakLine: true, paraSpaceAfter: 6 } },
    { text: "Pearl:", options: { bold: true, color: C.gold, fontSize: 12, fontFace: FONT, breakLine: true } },
    { text: "Limb apraxia may mimic comprehension deficit — always test comprehension with yes/no questions or pointing", options: { color: C.text, fontSize: 12, fontFace: FONT } },
  ], { x: 5.0, y: 2.15, w: 4.7, h: 3.1 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 — Transcortical & Anomic Aphasia
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Aphasia — Transcortical & Anomic"); footer(s);
  slideTitle(s, "Transcortical Aphasias & Anomic Aphasia");
  divider(s, 1.62);

  const types = [
    {
      name: "Transcortical Motor Aphasia",
      features: "Nonfluent; intact repetition (key); impaired naming; comprehension intact",
      lesion: "Left anterior frontal lobe (SMA area), sparing Broca area",
      note: "Repetition PRESERVED — distinguishes from Broca aphasia",
      color: C.accent,
    },
    {
      name: "Transcortical Sensory Aphasia",
      features: "Fluent with paraphasias; intact repetition (key); severely impaired comprehension",
      lesion: "Left posterior temporal-parietal area, sparing Wernicke area",
      note: "Repetition PRESERVED — distinguishes from Wernicke aphasia; may echo examiner (echolalia)",
      color: "EDF7ED",
    },
    {
      name: "Mixed Transcortical Aphasia",
      features: "Nonfluent; intact repetition; impaired comprehension and naming",
      lesion: "Isolation of speech area (border-zone infarctions)",
      note: "AKA isolation of the speech area — may echo any phrase heard",
      color: "FFF8E8",
    },
    {
      name: "Anomic Aphasia",
      features: "Fluent; naming prominently impaired; comprehension/repetition intact",
      lesion: "Variable; may be angular gyrus or temporal-parietal junction",
      note: "Often a residual state after recovery from other aphasias; least specific localizing value",
      color: "F7EEF7",
    },
  ];

  types.forEach((t, i) => {
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    s.addText(t.name, { x: x + 0.1, y: y + 0.04, w: 4.45, h: 0.35, fontSize: 12, fontFace: FONT, bold: true, color: C.navy });
    s.addText([
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      { text: t.features, options: { color: C.text, fontSize: 10, fontFace: FONT, breakLine: true } },
      { text: "Lesion: ", options: { bold: true, color: C.navy, fontSize: 10, fontFace: FONT } },
      { text: t.lesion, options: { color: C.text, fontSize: 10, fontFace: FONT, breakLine: true } },
      { text: "Pearl: ", options: { bold: true, color: C.teal, fontSize: 10, fontFace: FONT } },
      { text: t.note, options: { italic: true, color: C.navy, fontSize: 10, fontFace: FONT } },
    ], { x: x + 0.1, y: y + 0.42, w: 4.45, h: 1.2 });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 17 — Aphasia Syndromes Comparison Table
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Comparison Table"); footer(s);
  slideTitle(s, "Aphasia Syndromes — At-a-Glance");
  divider(s, 1.62);

  const tableData = [
    ["Syndrome", "Fluency", "Comprehension", "Repetition", "Lesion Site"],
    ["Broca", "NF", "Intact", "Impaired", "L inf frontal (BA44/45)"],
    ["Wernicke", "F", "Impaired", "Impaired", "L sup temporal (BA22)"],
    ["Global", "NF", "Impaired", "Impaired", "L MCA territory (large)"],
    ["Conduction", "F", "Intact", "IMPAIRED ★", "L sup temp / inf parietal"],
    ["Trans. Motor", "NF", "Intact", "Preserved ★", "L anterior frontal (SMA)"],
    ["Trans. Sensory", "F", "Impaired", "Preserved ★", "L post temp-parietal"],
    ["Mixed Trans.", "NF", "Impaired", "Preserved ★", "Border-zone (isolation)"],
    ["Anomic", "F", "Intact", "Intact", "Variable (angular gyrus)"],
  ];

  const colW3 = [1.8, 0.8, 1.55, 1.55, 3.9];
  const startX3 = [0.2, 2.05, 2.9, 4.5, 6.1];
  const cellH = 0.44;

  tableData.forEach((row, ri) => {
    const y = 1.72 + ri * cellH;
    const isHeader = ri === 0;
    row.forEach((cell, ci) => {
      const isHighlight = cell.includes("★");
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        x: startX3[ci], y, w: colW3[ci], h: cellH,
        fill: { color: isHeader ? C.navy : isHighlight ? "FFFAE0" : (ri % 2 === 0 ? C.accent : C.white) },
        line: { color: C.lightLine },
      });
      s.addText(cell, {
        x: startX3[ci] + 0.04, y: y + 0.04, w: colW3[ci] - 0.08, h: cellH - 0.08,
        fontSize: isHeader ? 10 : 9.5, fontFace: FONT,
        bold: isHeader || (ci === 0 && !isHeader),
        color: isHeader ? C.white : isHighlight ? "#8B5E00" : (ci === 0 ? C.navy : C.text),
        valign: "middle",
      });
    });
  });

  s.addText("NF = Non-fluent  |  F = Fluent  |  ★ = Hallmark feature", {
    x: 0.25, y: 5.28, w: 9.5, h: 0.22, fontSize: 8.5, fontFace: FONT, color: C.muted, italic: true, align: "center",
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 18 — Localization
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Localization"); footer(s);
  slideTitle(s, "Localization of Speech & Language Lesions");
  divider(s, 1.62);

  s.addText([
    { text: "Left hemisphere dominance for language: ", options: { bold: true, color: C.navy, fontSize: 13, fontFace: FONT } },
    { text: "~96% of right-handers; ~70% of left-handers", options: { color: C.text, fontSize: 13, fontFace: FONT, breakLine: true, paraSpaceAfter: 6 } },
  ], { x: 0.35, y: 1.72, w: 9.3, h: 0.5 });

  const locs = [
    { region: "Broca area (BA 44/45)", struct: "Left inferior frontal gyrus", disorder: "Broca aphasia, Apraxia of speech, Aphemia" },
    { region: "Wernicke area (BA 22)", struct: "Left posterior superior temporal gyrus", disorder: "Wernicke aphasia" },
    { region: "Arcuate fasciculus", struct: "White matter tract connecting temporal & frontal", disorder: "Conduction aphasia" },
    { region: "Perisylvian watershed", struct: "Border-zone cortex", disorder: "Transcortical aphasias (isolation)" },
    { region: "Left insula", struct: "Insular cortex (deep)", disorder: "Apraxia of speech (Dronkers, 1996)" },
    { region: "Left motor cortex (face area)", struct: "Primary motor cortex, face representation", disorder: "Aphemia, Acquired stuttering" },
    { region: "Cerebellum", struct: "Cerebellar hemispheres", disorder: "Ataxic dysarthria (scanning speech)" },
    { region: "Basal ganglia / Substantia nigra", struct: "Striatum, SN, STN", disorder: "Hypokinetic (PD) / Hyperkinetic dysarthria" },
    { region: "Bilateral perisylvian", struct: "Bilateral opercular cortex", disorder: "Opercular syndrome (Foix-Chavany-Marie)" },
  ];

  const cW = [2.8, 3.1, 3.6];
  const cX = [0.2, 3.05, 6.2];
  // header
  ["Region / Structure", "Anatomy", "Disorder(s)"].forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x: cX[i], y: 2.3, w: cW[i], h: 0.32, fill: { color: C.teal }, line: { color: C.teal } });
    s.addText(h, { x: cX[i] + 0.04, y: 2.3, w: cW[i] - 0.08, h: 0.32, fontSize: 10, fontFace: FONT, bold: true, color: C.white, valign: "middle" });
  });

  locs.forEach((r, ri) => {
    const y = 2.64 + ri * 0.32;
    const vals = [r.region, r.struct, r.disorder];
    vals.forEach((v, ci) => {
      s.addShape(pres.ShapeType.rect, { x: cX[ci], y, w: cW[ci], h: 0.30, fill: { color: ri % 2 === 0 ? C.accent : C.white }, line: { color: C.lightLine } });
      s.addText(v, { x: cX[ci] + 0.04, y: y + 0.02, w: cW[ci] - 0.08, h: 0.26, fontSize: 8.5, fontFace: FONT, color: ci === 0 ? C.navy : C.text, bold: ci === 0, valign: "middle" });
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 19 — Aphasia vs. Motor Speech Disorder
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Differential Diagnosis"); footer(s);
  slideTitle(s, "Aphasia vs. Motor Speech Disorder — Key Distinctions");
  divider(s, 1.62);

  const rows = [
    ["Feature", "Aphasia", "Motor Speech Disorder"],
    ["Core deficit", "Language (content)", "Articulation / speech mechanics"],
    ["Written language", "Also impaired", "Normal"],
    ["Comprehension", "Often impaired", "Normal"],
    ["Speech transcription", "Text reads abnormally", "Text reads normally"],
    ["Fluency type", "Reflects linguistic deficit", "Reflects motor deficit"],
    ["Reading", "Often impaired", "Normal (can read aloud poorly but comprehends)"],
    ["Brain locus", "Perisylvian cortex (language areas)", "Variable (motor cortex, cerebellum, BG, brainstem, NMJ, muscle)"],
  ];

  const cW4 = [2.2, 3.5, 3.8];
  const cX4 = [0.25, 2.5, 6.05];
  rows.forEach((row, ri) => {
    const y = 1.72 + ri * 0.45;
    const isHeader = ri === 0;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, {
        x: cX4[ci], y, w: cW4[ci], h: 0.43,
        fill: { color: isHeader ? C.navy : ci === 1 ? (ri % 2 === 0 ? "FFF3F0" : C.white) : (ri % 2 === 0 ? C.accent : C.white) },
        line: { color: C.lightLine },
      });
      s.addText(cell, {
        x: cX4[ci] + 0.06, y: y + 0.04, w: cW4[ci] - 0.12, h: 0.35,
        fontSize: isHeader ? 11 : 10, fontFace: FONT,
        bold: isHeader || ci === 0, color: isHeader ? C.white : (ci === 0 ? C.navy : C.text),
        valign: "middle",
      });
    });
  });

  s.addText("Practical pearl: Ask the patient to write — preserved writing rules out most motor speech disorders and points toward aphasia.", {
    x: 0.25, y: 5.22, w: 9.5, h: 0.3, fontSize: 9.5, fontFace: FONT, color: C.teal, bold: true,
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 20 — Management & Rehabilitation
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Management"); footer(s);
  slideTitle(s, "Management & Rehabilitation");
  divider(s, 1.62);

  s.addText([
    { text: "Speech-Language Therapy", options: { bold: true, color: C.teal, fontSize: 14, fontFace: FONT, breakLine: true } },
    { text: "Evidence supports efficacy of speech therapy for post-stroke dysarthria (Mackenzie, 2011) and aphasia (Bradley & Daroff, Ch.14)", options: { color: C.text, fontSize: 12, fontFace: FONT, breakLine: true, paraSpaceAfter: 8 } },
  ], { x: 0.35, y: 1.72, w: 9.3, h: 0.9 });

  const mgmt = [
    {
      title: "Dysarthria",
      items: ["Speech-language pathology referral", "Treat underlying cause (e.g., anti-parkinsonian agents, immunotherapy for MG)", "Augmentative & alternative communication (AAC) devices for severe cases", "LSVT (Lee Silverman Voice Treatment) for Parkinson disease"],
      color: C.accent,
    },
    {
      title: "Aphasia",
      items: ["Intensive speech-language therapy", "Constraint-induced aphasia therapy (CIAT)", "Melodic intonation therapy (MIT) for Broca aphasia — uses preserved right-hemisphere melody processing", "Address depression (especially Broca aphasia — high risk)", "Family/caregiver communication training"],
      color: "EDF7ED",
    },
  ];

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    const x = i === 0 ? 0.25 : 5.1;
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  s.addText("Prognosis: Best predictors of aphasia recovery include younger age, smaller lesion, preserved Wernicke area, early speech therapy initiation.", {
    x: 0.25, y: 5.28, w: 9.5, h: 0.22, fontSize: 9, fontFace: FONT, color: C.muted, italic: true,
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 21 — Clinical Pearls
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s); accentBar(s); headerBand(s, "Clinical Pearls"); footer(s);
  slideTitle(s, "Clinical Pearls for the Neurology Resident");
  divider(s, 1.62);

  const pearls = [
    { n: "1", text: "If a patient's TRANSCRIPTION reads normally → motor speech disorder, not aphasia. Always ask them to write." },
    { n: "2", text: "Repetition is the most important discriminating feature among aphasia syndromes — test it in every patient." },
    { n: "3", text: "Preserved repetition = Transcortical aphasia (motor or sensory) or Anomic aphasia → lesion outside the perisylvian core." },
    { n: "4", text: "Disproportionately impaired repetition with intact comprehension = Conduction aphasia (arcuate fasciculus lesion)." },
    { n: "5", text: "Inconsistent phonemic errors on repeating the same word 5× = Apraxia of speech. Consistent distortions = Dysarthria." },
    { n: "6", text: "Fluent aphasia + no hemiparesis = Wernicke aphasia until proven otherwise — can be mistaken for psychosis." },
    { n: "7", text: "Opercular syndrome: patient cannot open their mouth on command but yawns spontaneously — automatic-voluntary dissociation is pathognomonic." },
    { n: "8", text: "ALS = mixed spastic + flaccid dysarthria. Strain-strangle voice (UMN) + nasal/breathy (LMN) together is a red flag." },
    { n: "9", text: "Myasthenia gravis: speech fatigues DURING the examination — start with full paragraph reading." },
    { n: "10", text: "Parkinson disease: hypophonic + rapid festinating speech → LSVT is evidence-based treatment." },
  ];

  pearls.forEach((p, i) => {
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    const row = i % 5;
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 22 — Key Takeaways
// ══════════════════════════════════════════════════════════════════════════════
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  s.addShape(pres.ShapeType.line, { x: 0.5, y: 0.85, w: 4, h: 0, line: { color: C.teal, width: 2 } });

  const takeaways = [
    ["Motor Speech Disorders", "Problem is ARTICULATION — language content is normal. Subtypes: Dysarthria, Apraxia of Speech, and rare syndromes."],
    ["6 Dysarthria Types", "Flaccid (LMN/NMJ/Muscle) · Spastic (bilateral UMN) · Ataxic (cerebellum) · Hypokinetic (BG/PD) · Hyperkinetic (BG) · Mixed (ALS = both)"],
    ["Apraxia of Speech", "Inconsistent phonemic substitutions, effortful speech, left insula/Broca area. Test: repeat same polysyllabic word 5×."],
    ["Aphasia", "Language disorder — transcription reads abnormally. 6 domains: fluency, naming, comprehension, repetition, reading, writing."],
    ["Master Repetition", "Preserved + nonfluent = Transcortical Motor | Preserved + fluent = Transcortical Sensory | Impaired + fluent + intact comprehension = Conduction | All impaired + nonfluent = Global."],
  ];

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// ── Write file ──────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/speech-pptx/Speech_Neurology_Residents.pptx" })
  .then(() => console.log("DONE: /home/daytona/workspace/speech-pptx/Speech_Neurology_Residents.pptx"))
  .catch(err => { console.error(err); process.exit(1); });