Points summarised from Kaplan...
ACA is one of the terminal branches(smaller) of Internal Carotid Artery. The other's MCA.
Location---> consequent lesion:
1)medial surface and 1" superiorly on lateral aspect of frontal & parietal lobe : motor & sensory for pelvis+lowerlimb---> urinary incontinence+spastic paresis & anesthesia of C/L lowerlimb.
2)anterior 4/5ths of corpus callosum---> transcortical apraxia
3)anterior limb of internal capsule : papez circuit from thalamus to cingulum, part of the limbic system
About 1. good! But also note tht its USUALLY in B/L cases.
2. Transcortical apraxia is seen in lesions of the anterior 4/5th of the corpus callosum. A command to move the right hand is perceived by the receiving centre(Wernicke's), but is not passed to the appropriate hand moving centre, ie. the primary motor cortex on the right. BCOZ the fibres pass thru this corpus callosum. but he can move the right hand whnever he wants to...jsut not on command. You wont hv transcortical apraxia on the left coz the wernickes is on the left lobe. So the fibres dont need to pass thru corpus callosum.
3. Hvnt come across this one...but u know i think its more imp for USMLE to know effects of lesion in the posterior limb. so do tht well.
Kaplan patho...abulia is a general loss of all impulsivity...seen in frontal lobe lesions. Not sure if that is the cause for the 'transient' expressive aphasia. My advise, stick to kaplan neuroanat for neuroanat Qs...
hope sm1 can add more info.
Oops: noted my m istake just now! Geroo(refer post below) is right to point it out. Transcortical apraxia is related to the left limbs....as the right primary motor cortex fibres wud decussate in the pyramid!
well transcortical apraxia
drk has explained well... some more. the only way u can differntiate, is tell the patient to move the right hnd , he cant but u will see he will move his right hand if he has say a fly sitting on him ie without a command
this is because when u give command to the person, it will go first to the wernickes area, which is in the left hemisphere and then will go to the right motor cortex for execution of action, for this to happen it has to pass thro the corpus callosum. the aca supplies this, and when aca is gone, the ant 4/5 of the corpus callosum is not working and hence the information cant go to the right hemisphere and he will not execute the action
but now u tell him to move his right hand, now the info goes to the wernickes area and then to the left cortex for execution of the plan, now in this case it does not have to pass thro the corpus callosum
hence we conclude that transcortical apraxia, is inability to move the right hand on command
good explanation sturge and drk,but in transcortical apraxia the patient can't excute command to move his left limb not right.
지난달 아놀드 슈워제네거 캘리포니아 주지사가 서명한 2009~2010년 예산안에 정부보조 의료보험 메디칼(Medi-Cal)에서 침 치료 혜택을 제외하는 내용이 포함된 것으로 밝혀졌다.
캘리포니아 주정부는 400억달러가 넘는 재정적자를 해결하기 위해 전 부서에 걸쳐 총 150억달러에 이르는 긴축재정과 예산삭감 정책을 발표했고, 침 치료를 메디칼 대상에서 제외하는 내용이 포함됐다.
침 치료의 메디칼 폐지는 오는 7월1일부터 실시되며 침 치료 외에도 카이로프랙틱 치료와 심리상담, 검안, 치과 치료 등도 메디칼 대상에서 제외됐다.
가주한의사협회(회장 김갑봉)는 “침 치료는 지난 80년대부터 메디칼 대상으로 포함돼 저렴한 진료비와 우수한 치료효과로 환자와 보험사 모두에게 이득을 주었다”며 “어렵게 명맥을 유지해 오던 메디칼 침 치료 커버리지가 중단됨에 따라 한의사들은 물론 환자들도 피해를 입게 됐다”고 밝혔다.
메디칼은 침 치료를 선택 수혜사항으로 분류해 환자 1인당 최고 30달러까지 진료비 수가를 지급해 왔다. 가주한의사협회 남형각 사무국장은 “주정부가 메디칼 침 치료에 대해 지급하는 진료비가 1회에 5.75달러에 불과하다”며 “메디칼 침치료 폐지는 경제적인 문제보다는 정부 의료보험인 메디칼이 침 치료를 제외하면서 일반 의료보험에도 영향을 미치는 것이 더 중대한 문제”라고 지적했다.