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just above the basilar bifurcation, supply the red nuclei, the substantia nigra bilaterally, medial parts of the cerebral peduncles, oculomotor and trochlear nuclei and nerves, reticular substance of the upper brainstem, decussation of the brachia conjunctivae (superior cerebellar peduncles), medial longitudinal fasciculi, and medial lemnisci The portion of the posterior cerebral artery giving rise to the interpeduncular branches (the portion between the bifurcation of the basilar artery and the ostium of the posterior communicating artery) is also referred to as the mesencephalic artery or the basilar communicating artery The thalamoperforate branches (also called paramedian thalamic arteries) arise slightly more distally, near the junction of the posterior cerebral and posterior communicating arteries (P2 segment of the artery) and supply the inferior, medial, and anterior parts of the thalamus As pointed out by Percheron (whose name is often applied to the largest of these vessels), the arterial con guration of the thalamoperforate arteries varies considerably: in some cases they arise symmetrically, one from each side; in others, both arteries arise from the same posterior cerebral stem, either separately or by a common trunk, which then bifurcates In the latter case, one posterior cerebral stem supplies the medial thalamic territories on both sides, and an occlusion of this artery or one common paramedian trunk produces a bilateral butter y-shaped lesion in the medial parts of the diencephalon The thalamogeniculate branches arise still more distally, opposite the lateral geniculate body, and supply the geniculate body and the central and posterior parts of the thalamus Medial branches from the posterior cerebral, as it encircles the midbrain, supply the lateral part of the cerebral peduncle, lateral tegmentum and corpora quadrigemina, and pineal gland Posterior choroidal branches run to the posterosuperior thalamus, choroid plexus, posterior parts of the hippocampus, and psalterium (decussation of fornices) The terminal or cortical branches of the posterior cerebral artery supply the inferomedial part of the temporal lobe and the medial occipital lobe, including the lingula, cuneus, precuneus, and visual Brodmann s areas 17, 18, and 19 (see Figs 34-6, 34-8, and 34-9) Occlusion of the posterior cerebral artery produces a greater variety of clinical effects than occlusion of any other artery because both the upper brainstem, which is crowded with important structures, and the inferomedial parts of the temporal and occipital lobes lie within its domain Obviously, the site of the occlusion and the arrangement of the circle of Willis will in large measure determine the location and extent of the resulting infarct For example, occlusion proximal to the posterior communicating artery may be asymptomatic or have only transitory effects if the collateral ow is adequate from the opposite posterior cerebral vessel (Fig 34-8; see also Fig 34-9) Even distal to the posterior communicating artery, an occlusion may cause relatively little damage if the collateral ow through border-zone collaterals from anterior and middle cerebral arteries is suf cient In the series of posterior cerebral artery strokes studied by Milandre and coworkers, the causes were in general similar to those of strokes in other vascular territories except that there was a surprisingly high incidence of atherosclerotic occlusion (35 patients) in contrast to cardioembolic types (15 patients) Two of their stroke cases were attributed to migraine Our experience has differed in that the proportion of presumed embolic occlusions has been far greater than that of other causes For convenience of exposition, it is helpful to divide the posterior cerebral artery syndromes into three groups: (1) anterior and.

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Class-AB2 and class-B amplifiers take some power from the input signal source Engineers say that such amplifiers require a certain amount of drive or driving power to function Class-A and class-AB1 amplifiers theoretically need no driving power, although there must be an input voltage

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proximal (involving interpeduncular, thalamic perforant, and thalamogeniculate branches), (2) cortical (inferior temporal and medial occipital), and (3) bilateral Anterior and Proximal Syndromes (See Figs 34-9 and 34-10) The thalamic syndrome of Dejerine and Roussy (page 141) fol lows infarction of the sensory relay nuclei in the thalamus, the result of occlusion of thalamogeniculate branches There is both a deep and cutaneous sensory loss, usually severe in degree, of the opposite side of the body, including the trunk and face, sometimes accompanied by a transitory hemiparesis A homonymous hemianopia may be conjoined In some instances there is a dissociated sensory loss pain and thermal sensation being more affected than touch, vibration, and position or only one part of the body may be anesthetic But again, the characteristic feature is sensory loss that includes the entire hemibody up to the midline After an interval, sensation begins to return, and the patient may then develop pain, paresthesia, and hyperpathia in the affected parts The painful paresthetic syndrome may persist for years There may also be distortion of taste, athetotic posturing of the hand, and alteration of mood Mania and depression have occasionally been observed with infarction of the diencephalon and adjacent structures, but the data are usually incomplete Central midbrain and subthalamic syndromes are due to occlusion of the interpeduncular branches of the posterior cerebral artery The clinical syndromes include palsies of vertical gaze, stupor, or coma Syndromes of the paramedian arteries, including the proximal posterior cerebral artery, have as their main feature a third nerve palsy combined with contralateral hemiplegia (Weber syndrome), contralateral ataxic tremor (Benedikt syndrome), or ataxia and hemiparesis (Claude syndrome) as summarized in Table 34-3, page 681 Anteromedial-inferior thalamic syndromes follow occlusion of the thalamoperforant branches Here the most common effect is an extrapyramidal movement disorder (hemiballismus or hemichoreoathetosis or less often, asterixis) Deep sensory loss, hemiataxia, or tremor may be added in various combinations Hemiballismus is usually due to occlusion of a small branch to the subthalamic nucleus (of Luys) or its connections with the pallidum Occlusion of the paramedian thalamic branch(es) to the mediodorsal thalamic nuclei or to the dominant (left) mediodorsal nucleus is a recognized.

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5 Figure 34-10 Diagram of the vascularization of the diencephalon Distribution of (1) the anterior cerebral artery, (2) the posterior cerebral artery, (3) the anterior and posterior choroidal arteries, (4) the posterior communicating artery, and (5) the internal carotid artery (Reproduced by permission from Krayenbuhl and Yasargil)

A bipolar transistor or FET can be biased past cutoff or pinchoff, and it will still work as a power amplifier (PA), provided that the drive is sufficient to overcome the bias during part of the cycle You might think, at first, that this bias scheme couldn t possibly result in amplification Intuitively, it seems as if this could produce a marginal signal loss, at best But in fact, if there is significant driving power, class-C operation can work very well And, it is more efficient than any of the aforementioned methods The operating points for class C are labeled in Figs 24-4 and 24-5 Class-C PAs are never linear, even for amplitude modulation on a signal Because of this, a class-C circuit is useful only for signals that are either full-on or full-off Continuous-wave (CW), also known as Morse code, and radioteletype (RYTY) are examples of such signals Class-C PAs also work well with frequency modulation (FM) because the amplitude never changes A class-C PA needs a lot of drive The gain is fairly low It might take 300 W of radio-frequency (RF) drive to get 1 kW of RF power output That s a gain of only a little

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