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Visual cortex with striate area along calcarine sulcus Medial orbito-frontal A Ant cerebral A Post cerebral A Calcarine A Post temporal A Ant temporal A Figure 34-6 Diagram of a cerebral hemisphere, medial aspect, showing the branches and distribution of the anterior cerebral artery and the principal regions of cerebral localization Below is a list of the clinical manifestations of infarction in the territory of this artery and the corresponding regions of cerebral damage Also shown is the course of the main branch of the posterior cerebral artery on the medial side of the hemisphere

Signs and symptoms Paralysis of opposite foot and leg A lesser degree of paresis of opposite arm Cortical sensory loss over toes, foot, and leg Urinary incontinence Contralateral grasp re ex, sucking re ex, gegenhalten (paratonic rigidity), frontal tremor Abulia (akinetic mutism), slowness, delay, lack of spontaneity, whispering, motor inaction, re ex distraction to sights and sounds Impairment of gait and stance (gait apraxia ) Mental impairment (perseveration and amnesia) Miscellaneous: dyspraxia of left limbs Tactile aphasia in left limbs Cerebral paraplegia

Note: Hemianopia does not occur; transcortical aphasia occurs rarely (page 423)

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In this amplifier, the capacitors must have values large enough to allow the ac signal to pass with ease But they shouldn t be much larger than the minimum necessary for this purpose If an 01- F capacitor will suffice, there s no point in using a 47- F capacitor That would introduce unwanted losses into the circuit, and would also make the circuit needlessly expensive to build The ideal capacitance values depend on the design frequency of the amplifier, and also on the impedances at the input and output In general, as the frequency and/or circuit impedance increase, less and less capacitance is needed At audio frequencies, say 300 Hz to 20 kHz, and at low impedance, the capacitors might be as large as 100 F At radio frequencies, such as 1 MHz to 50 MHz, and with high impedances, values will be only a

Structures involved Motor leg area Involvement of arm area of cortex or bers descending therefrom to corona radiata Sensory area for foot and leg Posteromedial part of superior frontal gyrus (bilateral) Medial surface of the posterior frontal lobe ( ) Uncertain localization probably superomedial lesion near subcallosum Inferomedial frontal striatal ( ) Localization unknown Corpus callosum Corpus callosum Motor leg area bilaterally (due to bilateral occlusion of anterior cerebral arteries)

in the neck With severe atherosclerotic stenosis at the level of the carotid sinus, with or without a superimposed thrombus, auscultation frequently discloses a bruit, best heard with the bell of the stethoscope held against the skin just tightly enough to create a seal (excessive pressure creates a diaphragm of the skin and lters the low-pitched frequencies that are typical of the bruit of carotid stenosis) Occasionally a bruit is due to stenosis at the origin of the external carotid artery or is a radiated murmur from the aortic valve and can then be misleading If the bruit is loudest at the angle of the jaw, the stenosis usually lies at the proximal internal carotid; if heard lower in the neck, it is in the common carotid or subclavian artery Rarely, stenosis in vertebral arteries or vascular malforma-

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tions at the base of the brain may produce bruits heard posteriorly in the neck The duration and quality of the bruit are relevant bruits that extend into diastole and are high-pitched are almost invariably associated with a tight stenosis (lumen l5 mm) An additional though infrequent sign of carotid occlusion is the presence of a bruit over the opposite carotid artery, heard best by placing the bell of the stethoscope over the eyeball (ocular bruit) As pointed out by Pessin and colleagues (1983), this murmur is often due to augmented circulation through the patent vessel but there are as many instances in our experience when a bruit over the eye instead re ects a stenosis in the intracranial portion of the carotid artery on

438 Amplifiers fraction of a microfarad, down to picofarads at the highest frequencies and impedances The exact values are determined by the design engineers, working to optimize circuit performance in the lab The resistor values likewise depend on the application Typical values are R1 470 , R2 47 K , R3 10K , and R4 47 K for a weak-signal, broadband amplifier If the circuit is used as a power amplifier, such as in a radio transmitter or a stereo hi-fi amplifier, the values of the resistors will be different It might be necessary to bias the base negatively with respect to the emitter, using a second power supply with a voltage negative with respect to ground

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